Job Description
Our client, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation for their Orange, CA /Remote location.
Responsibilities:
Requirements:
Why Should You Apply?
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:
- Years of experience: 3+ years of relevant experience
- Bachelor’s degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- Experience 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
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
Numbers & Facts
| Location | Orange, CA |
| Industry | Management Consulting Services |
| Salary | $47–$52 Per Hour |
| Company Size | 2,000 to 2,499 employees |
| Year Founded | 2000 |
| Website | https://www.iconma.com/ |
Benefits
401K, Employee Referral Program, Life Insurance
About Company
ICONMA is a global information consulting management firm providing Professional Staffing Services and Project-Based Solutions for organizations in a broad range of industries.
- Corporate Headquarters in Troy, Michigan; 20+ locations worldwide.
- Certified Woman-Owned Business Enterprise (WBE); certified by Women’s Business Enterprise National Council, National Women Business Owners Corporation (NWBOC); and California Public Utilities Commission (CPUC).
- Founded in 2000
- 2000+ Employees
The company was founded on the principle that success is derived from delivering high quality service and resources in the most responsive, flexible, and innovative way. ICONMA invests in people and resources with a single goal: To provide our customers with the highest quality service in the most responsive manner. Through its network of offices, ICONMA provides the resources to help clients maintain their competitive advantage.
Skills
- Alliance/Partner Managementunmatched
- Analysis Skillsunmatched
- Applications Securityunmatched
- Business Solutionsunmatched
- Claims Codingunmatched
- Claims Managementunmatched
- Claims Processingunmatched
- Computer Skillsunmatched
- Cost Controlunmatched
- Customer Relationsunmatched
- Data Collectionunmatched
- Develop and Maintain Customersunmatched
- Health Planunmatched
- Insurance Regulationsunmatched
- Litigationunmatched
- Medical Protocolsunmatched
- Medical Treatmentunmatched
- Medicareunmatched
- Microsoft Officeunmatched
- Microsoft Product Familyunmatched
- Negotiation Skillsunmatched
- Organizational Skillsunmatched
- Presentation/Verbal Skillsunmatched
- Process Analysisunmatched
- Process Managementunmatched
- State Laws and Regulationsunmatched
- Subrogationunmatched
- Team Playerunmatched
- Time Managementunmatched
- Vendor/Supplier Planningunmatched
- Worker's Compensationunmatched
- Writing Skillsunmatched
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