Workers Compensation Claims Examiner

2 days ago

Pasadena, California, United States Mary Kraft HR Full time
{"Job Title": "Workers Compensation Claims Examiner", "Job Description": "Job Summary

Mary Kraft HR is seeking an experienced Workers Compensation Claims Examiner to handle complex workers' compensation claims, including high exposure claims involving litigation and rehabilitation.

This position requires analysis and adjudication of claims within service expectations, industry best practices, and client requirements.

Key Responsibilities:
  • Analyze and process complex or technically difficult workers' compensation claims, investigating and gathering information to determine exposure and managing claims through well-developed action plans.
  • Oversee and manage the litigation process, ensuring timely and cost-effective resolution of claims.
  • Negotiate claim settlements within designated authority, ensuring appropriate reserves are maintained throughout the life of the claim.
  • Prepare and file necessary state filings within statutory limits and ensure claims are processed in compliance with relevant regulations.
  • Use cost containment techniques, including vendor partnerships, to reduce claim costs.
  • Manage claim recoveries, including subrogation, Second Injury Fund recoveries, Social Security, and Medicare offsets.
  • Report claims to the excess carrier and respond to requests promptly.
  • Maintain clear and professional communication with claimants, clients, and other stakeholders.
  • Ensure claim files are properly documented, and claims coding is accurate.
  • Work effectively with the team, supporting the organization's quality programs and helping with training as needed.
Requirements:
  • Minimum of 3 years of workers compensation claims management experience, with experience handling public entity or County of Los Angeles claims considered a plus.
  • Must hold a valid Self Insurance Plans (SIP) Certificate.
  • Expertise in workers compensation principles and laws.
  • Strong knowledge of medical management practices, Social Security, and Medicare offset procedures.
  • Excellent negotiation, communication, and presentation skills.
  • Proficient in Microsoft Office and claims management software.
  • Strong analytical, organizational, and problem-solving abilities.
  • Ability to meet or exceed service expectations.
  • Ability to work well in a team environment.
", "Language": "en"}

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