Workers Compensation Claims Examiner

4 days ago


California City, California, United States Apidel Technologies Full time
Job Summary

Apidel Technologies is seeking a skilled Workers Compensation Claims Examiner to join our team. As a key member of our claims team, you will be responsible for analyzing and processing complex workers' compensation claims, ensuring timely and cost-effective resolution.

Key Responsibilities
  • Analyze and process complex workers' compensation claims, investigating and gathering information to determine exposure and manage claims through well-developed action plans.
  • Negotiate settlements within designated authority and calculate and assign timely and appropriate reserves to claims.
  • Calculate and pay benefits due, approve and make timely claim payments and adjustments, and settle claims within designated authority level.
  • Prepare necessary state filings within statutory limits and manage the litigation process, ensuring timely and cost-effective claims resolution.
  • Coordinate vendor referrals for additional investigation and/or litigation management, and use appropriate cost containment techniques to reduce overall cost of claims for our clients.
  • Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets, and report claims to the excess carrier.
  • Communicate claim activity and processing with the claimant and the client, maintaining professional client relationships, and ensure claim files are properly documented and claims coding is correct.
Requirements

Minimum 3 years of relevant CA WC claims experience is mandatory. California WC Claims handling experience is required. Primary purpose is to analyze complex or technically difficult workers' compensation claims to determine benefits due, work with high exposure claims involving litigation and rehabilitation, ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements, and identify subrogation of claims and negotiate settlements.



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