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Claims Examiner - Workers Compensation

ICONMA, LLC

Long Beach, CA

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JOB DETAILS
SALARY
$45–$50 Per Hour
SKILLS
Alliance/Partner Management, Analysis Skills, Applications Security, Auditory, Business Solutions, Claims Coding, Claims Management, Claims Processing, Computer Skills, Cost Control, Customer Relations, Data Collection, Develop and Maintain Customers, Health Plan, Identify Issues, Insurance Regulations, Litigation, Medical Protocols, Medical Treatment, Medicare, Microsoft Office, Microsoft Product Family, Multitasking, Negotiation Skills, Organizational Skills, Presentation/Verbal Skills, Problem Solving Skills, Process Analysis, Process Management, State Laws and Regulations, Subrogation, Team Player, Time Management, Vendor/Supplier Planning, Worker's Compensation, Writing Skills
LOCATION
Long Beach, CA
POSTED
23 days ago
Our client, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation for their Long Beach, CA/Roseville, 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.
  • Performs other duties as assigned.
  • Supports the organization's quality program(s).
 
Requirements:
  • Candidate with prior/current CA Indemnity and Litigated Workers Compensation experience is required.
  • Self-Insured Plans certification.
  • Bachelor's degee from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
  • Five (5) years of claims management experience or equivalent combination of education and experience required.
  • Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Analytical and interpretive skills
  • Strong organizational skills
  • Good interpersonal skills
  • Excellent negotiation skills
  • Ability to work in a team environment
  • Ability to meet or exceed Service Expectations
Work Environment
  • When applicable and appropriate, consideration will be given to reasonable accommodations.
  • Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
  • Physical: Computer keyboarding
  • Auditory/Visual: Hearing, vision and talking
 
Why Should You Apply?

About the Company

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ICONMA, LLC

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