Workers Compensation Senior Claim Representative
2 weeks ago
We are looking for an experienced Workers' Compensation Senior Claim Representative to join our team in Los Angeles, California. In this role, you will oversee the management of workers' compensation lost time claims, ensuring compliance with statutory regulations and delivering exceptional customer service throughout the claims process. This is a long-term contract position requiring strong analytical, communication, and organizational skills.
Responsibilities:
- Manage all aspects of workers' compensation lost time claims from initial setup to resolution, maintaining high standards of customer service.
- Conduct thorough investigations to gather facts, obtain statements, and assess compensability of claims.
- Administer statutory medical and indemnity benefits promptly and accurately throughout the duration of each claim.
- Collaborate with attorneys to oversee hearings and manage litigation processes effectively.
- Establish and adjust reserve amounts for medical, indemnity, and related expenses within authority limits.
- Coordinate with vendors, nurse case managers, and rehabilitation managers to ensure optimal medical management and return-to-work initiatives.
- Prepare detailed reports documenting investigation outcomes, claim settlements, denials, and evaluations.
- Ensure compliance with state regulations by accurately filing workers' compensation forms and electronic data.
- Refer claims for subrogation and facilitate recovery opportunities by securing necessary documentation.
- Work closely with internal teams, including technical assistants and special investigators, to exceed customer expectations and deliver superior claims handling.
Requirements:
- Proven experience as a lost time examiner or in a similar role handling workers' compensation or disability claims.
- Strong understanding of workers' compensation statutes, regulations, and compliance requirements.
- Demonstrated ability to analyze data and use modeling to resolve claims efficiently.
- Excellent communication and interpersonal skills to liaise with claimants, insureds, and legal professionals.
- Proficiency in managing litigation and coordinating with attorneys and third-party vendors.
- Familiarity with state-specific filing procedures and electronic data submission for compliance.
- Skilled in using Microsoft Office Suite and other relevant tools for documentation and reporting.
- Exceptional organizational and time management abilities to handle multiple claims simultaneously.
Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary, and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training.
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Los Angeles, CA, United States TSR Consulting Full timeOur client, a leading insurance company, is hiring a Worker's Compensation Senior Claim Representative on a contract basis Job ID #: 83871 Work Location : Los Angeles, CA/ONSITE Summary: Job schedule-40 hours on site Job hours-8:00-4:30 Interview process-WEBEX prescreen/Then in-person interview Job Description : Client is currently...
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Los Angeles, CA, United States TSR Consulting Full timeOur client, a leading insurance company, is hiring a Worker's Compensation Senior Claim Representative on a contract basis Job ID #: 83871 Work Location: Los Angeles, CA/ONSITE Summary: Job schedule-40 hours on site Job hours-8:00-4:30 Interview process-WEBEX prescreen/Then in-person interview Job Description: Client is currently seeking a Workers...
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