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Claims Examiner - Workers Compensation (Hourly)

ICONMA, LLC

Brea, CA

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JOB DETAILS
SALARY
$43–$48 Per Hour
SKILLS
Alliance/Partner Management, Business Solutions, Claims Coding, Claims Management, Claims Processing, Cost Control, Customer Relations, Data Collection, Develop and Maintain Customers, Health Plan, Litigation, Medicare, Negotiation Skills, Process Analysis, Process Management, State Laws and Regulations, Subrogation, Time Management, Vendor/Supplier Planning, Worker's Compensation
LOCATION
Brea, CA
POSTED
13 days ago
Our Client, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation (Hourly) for their Brea, CA location.
 
Responsibilities:
  • Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
  • Negotiates settlement of claims within designated authority.
  • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
  • Prepares necessary state fillings within statutory limits.
  • Manages the litigation process; ensures timely and cost effective claims resolution.
  • Coordinates vendor referrals for additional investigation and/or litigation management.
  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
  • Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
  • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
  • Ensures claim files are properly documented and claims coding is correct.
  • Refers cases as appropriate to supervisor and management.
 
Requirements:
  • Bachelor's degree from an accredited college or university preferred.
  • Professional certification as applicable to line of business preferred.
 
Why Should You Apply?#mcb

About the Company

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ICONMA, LLC

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