Claims Examiner
2 weeks ago
Claims Examiner - Workers Compensation
BC Forward is looking for Claims Examiner - Workers Compensation in Orange, CA 92868
Position Title: Claims Examiner - Workers Compensation
Locations: 333 City Boulevard West, Orange, CA 92868
Anticipated Start Date: 11/03
Expected Duration: 2+ Months
Job Type: Contract with possible extension
Pay Rate $47.00/hr. on W2
Need: Minimum 3-5 years of workers' compensation claims management experience required.
Job Description:
Primary Purpose
Responsible for analyzing complex or technically challenging workers' compensation claims to determine benefits due. This includes managing high-exposure cases involving litigation and rehabilitation, ensuring timely and accurate claim adjudication in line with service expectations, industry best practices, and client-specific requirements. The role also involves identifying subrogation opportunities and negotiating settlements.
Essential Responsibilities
- Analyze, investigate, and process complex workers' compensation claims to determine exposure and liability.
- Develop and execute effective action plans to ensure timely claim resolution.
- Negotiate claim settlements within assigned authority limits.
- Establish, review, and maintain adequate reserves throughout the claim lifecycle.
- Calculate and disburse benefits accurately and in compliance with regulations.
- Prepare and file all required state documentation within statutory deadlines.
- Manage the litigation process efficiently, ensuring cost-effective outcomes.
- Coordinate with vendors for investigation, medical management, and litigation support.
- Apply cost-containment strategies and vendor partnerships to reduce claim expenses.
- Manage recoveries such as subrogation, Second Injury Fund, and Social Security/Medicare offsets.
- Communicate claim activity clearly and professionally with clients, claimants, and internal teams.
- Ensure complete and accurate claim documentation and coding.
- Escalate complex cases to supervisors or management as necessary.
- Support the organization's quality and compliance programs.
- Perform other duties as assigned.
- Travel as required.
Education & Licensing:
- Bachelor's degree preferred.
- Relevant professional certifications preferred.
- Minimum 3-5 years of workers' compensation claims management experience required.
- In-depth understanding of workers' compensation laws, claim adjudication, cost-containment principles, and recovery processes.
- Proficiency in Microsoft Office and claim management systems.
- Strong analytical, negotiation, and communication skills.
- Excellent organizational and multitasking abilities.
- Demonstrated ability to work collaboratively in a team environment and meet service standards.
Mental: Strong analytical thinking, judgment, and problem-solving skills; ability to manage multiple priorities under deadlines.
Physical: Regular computer use; occasional travel required.
Auditory/Visual: Clear communication, hearing, and vision required.
Note: Employment is contingent upon successful completion of a background and credit check.
Manager's Note:
This is a hybrid role based in Orange, CA (2 days onsite weekly). Candidates must have a minimum of 3 years of Workers' Compensation claims examiner experience.
About BCforward
Founded in 1998, BCforward is a Black-owned global leader in workforce management and digital product delivery solutions, headquartered in Indianapolis, IN. With a worldwide team of over 6,000 consultants, BCforward is dedicated to empowering human potential through its core values: People-Centricity, Excellence, and Diversity.
As an industry pioneer, BCforward provides a best-in-class workplace, fostering a culture of accountability, innovation, and optimism. Committed to equal opportunity employment, the company champions diversity and inclusion, striving to create a positive impact for its clients, employees, and communities.
Interested candidates please send resume in Word format Please reference job code 246171 when responding to this ad.
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