Job Title: Claims Adjuster II Location: Brea, CA, Downers Grove, IL, Walnut Creek, CA, Portland, OR, Los Angeles, CA Job Type: W2 Contract Expected hours per week: 40 hours per week Schedule: Hybrid Pay Range: $38-60 per hour Job Description: Job Summary Workers Compensation Claims Specialist, West Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines:
Interprets more complex or unusual policy coverages and determines if coverages apply to claims submitted, escalating issues as needed.
Sets activities, reserves and authorizes payments within scope of authority. Ensures issuance of disbursements while managing loss costs and expenses.
Coordinates and performs investigations and evaluates claims and suits through contact with insureds, claimants, business partners, witnesses and experts. Seeks early resolution opportunities. Identifies files that have potential fraud and refers to SIU.
Utilizes negotiation skills to develop complex settlement packages.
Identifies claims with third party recovery potential and coordinates with subrogation/salvage unit.
Partners with attorneys, account representatives, agents, underwriters, doctors, nurse case managers and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims.
Analyzes claims activities. Prepares and presents reports for management. May be responsible for special projects and presentations.
Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes.
May provide guidance and assistance to other claims staff and functional areas.
Keeps current on state/territory regulations and issues as well as industry activity and trends.
Skills, Knowledge & Abilities:
Solid knowledge of claims and insurance industry theory and practices.
Demonstrated technical expertise and product specific knowledge.
Strong interpersonal, communication and negotiation skills. Ability to effectively interact with all levels of CNA's internal and external business partners.
Ability to work independently, managing time and resources to accomplish multiple tasks and meet deadlines.
Strong analytical and problem solving skills enabling viable alternative solutions.
Ability to exercise independent judgement and make critical business decisions effectively assessing the merits of claims as well as evaluating claims based on a cost benefit analysis.
Solid knowledge of Microsoft Office Suite as well as other business-related software.
Ability to adapt to change and value diverse opinions and ideas.
Ability to fully comprehend claim information; and to further articulate analyses of claims in internal reports.
Ability to handle claims with a proactive long-term view of business goals and objectives.
Education & Experience:
Bachelor's degree or equivalent experience. Professional designations preferred.
Typically a minimum three to five years claims experience.
CA Certifcation required.
#L1-NG1 #INDOEM
Numbers & Facts
Location
Brea, CA
Salary
$38–$60 Per Hour
Skills
Analysis Skillsunmatched
Certified Case Manager (CCM)unmatched
Claims Processingunmatched
Communication Skillsunmatched
Cost Benefit Analysisunmatched
Cost Controlunmatched
Data Entryunmatched
Disbursementsunmatched
Industry/Trade Analysisunmatched
Insuranceunmatched
Insurance Claimsunmatched
Interpersonal Skillsunmatched
Microsoft Officeunmatched
Multitaskingunmatched
Negotiation Skillsunmatched
People Managementunmatched
Problem Solving Skillsunmatched
Resource Managementunmatched
State Laws and Regulationsunmatched
Strategic Planningunmatched
Subrogationunmatched
Time Managementunmatched
Underwritingunmatched
Worker's Compensationunmatched
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