Job Description
Job Description
Job Description
Job Profile
Job Title: Claims Examiner
Location: Remote
Hire Type: Contingent
Pay Range: $67/hr.
Work Model:Remote
Work Shift: Monday-Friday 8 am – 4 pm
Recruiter Contact:Sean Craft I sean@marykraft.com I 443-345-3305
Nature & Scope:
Positional Overview
We are seeking an experienced Workers Compensation Claims Examiner to manage and resolve complex workers’ compensation claims. This role is responsible for analyzing claim exposure, determining benefits due, handling litigated and high-exposure claims, negotiating settlements, and ensuring claims are adjudicated in accordance with client requirements, industry regulations, and best practices.
The ideal candidate will possess strong investigative, analytical, and negotiation skills, along with extensive experience handling workers’ compensation claims from inception through resolution.
Role & Responsibility:
Tasks That Will Lead to Your Success
- Analyze and process complex workers’ compensation claims by conducting investigations and gathering information to determine claim exposure and compensability.
- Develop and execute strategic action plans to drive claims toward timely and appropriate resolution.
- Negotiate settlements within established authority limits.
- Calculate, establish, and maintain appropriate claim reserves throughout the life of the claim.
- Determine benefits due and authorize claim payments and adjustments in accordance with applicable regulations and authority levels.
- Prepare and submit required state filings within statutory deadlines.
- Manage litigated claims and coordinate with defense counsel, medical providers, investigators, and other vendors to ensure efficient claim resolution.
- Utilize cost-containment strategies and vendor partnerships to minimize claim costs while maintaining quality outcomes.
- Identify and pursue recovery opportunities, including subrogation, Second Injury Fund recoveries, and Social Security or Medicare offsets.
- Report claims to excess carriers and respond to requests for information and direction in a timely and professional manner.
- Maintain regular communication with claimants, clients, attorneys, medical providers, and internal stakeholders regarding claim activity and status.
- Ensure claim files are accurately documented and properly coded within the claims management system.
- Escalate complex issues and claims to management as appropriate.
- Support organizational quality initiatives and perform additional duties as assigned.
Skills & Experience
Qualifications That Will Help You Thrive
- High school diploma or GED required.
- Bachelor’s degree from an accredited college or university preferred.
- Professional certifications related to workers’ compensation claims handling preferred.
- Minimum of five (5) years of workers’ compensation claims management experience or an equivalent combination of education and experience.
- Experience handling complex, litigated, and high-exposure workers’ compensation claims preferred.
- Strong understanding of California workers’ compensation laws and regulations is highly desirable.
- In-depth knowledge of workers’ compensation insurance principles, laws, and claims management practices.
- Understanding of reserve management, claim recoveries, offsets, and deductions.
- Knowledge of medical management practices and Social Security/Medicare procedures.
- Strong investigative, analytical, and problem-solving skills.
- Excellent negotiation and settlement management abilities.
- Strong written and verbal communication skills, including presentation capabilities.
- Proficiency in Microsoft Office Suite and claims management systems.
- Strong organizational and time management skills with the ability to manage multiple priorities.
- Ability to work independently and collaboratively in a team environment.
- Commitment to delivering exceptional customer service and meeting performance expectations.
Numbers & Facts
| Location | Brea, CA (Remote) |
| Industry | Staffing/Employment Agencies |
| Company Size | 20 to 49 employees |
About Company
There’s an opportunity here. But it’s opportunity that imagination alone can’t fulfill.
But Imagine can.
From the time we’re kids, we define our future by what we’re going to be. Doctor. Fireman. Astronaut. To make it happen takes a vision of what’s possible, but it also takes something more.
Imagine Staffing has been helping organizations find the right talent—and talent find the right employers—with an approach that starts with vision, and carries through with persistence, commitment, and teamwork.
As a client, you don’t get résumés, you receive thoroughly screened candidates who are ready to step in and fill the void. As a job seeker, you get personalized attention, which highlights both your personal strengths and aspirations so we can find the right fit.
Skills
- Adjudicationunmatched
- Alliance/Partner Managementunmatched
- Analysis Skillsunmatched
- Best Practicesunmatched
- Claims Managementunmatched
- Claims Processingunmatched
- Communication Skillsunmatched
- Cost Controlunmatched
- Customer Support/Serviceunmatched
- Data Collectionunmatched
- Healthcare Providersunmatched
- High School Diplomaunmatched
- Insurance Regulationsunmatched
- Litigationunmatched
- Medical Treatmentunmatched
- Medicareunmatched
- Microsoft Officeunmatched
- Multitaskingunmatched
- Negotiation Skillsunmatched
- Organizational Skillsunmatched
- Presentation/Verbal Skillsunmatched
- Problem Solving Skillsunmatched
- Process Analysisunmatched
- Quality Assuranceunmatched
- Quality Managementunmatched
- Regulationsunmatched
- Request for Information (RFI)unmatched
- Strategic Planningunmatched
- Subrogationunmatched
- Time Managementunmatched
- Vendor/Supplier Evaluationunmatched
- Vendor/Supplier Planningunmatched
- Worker's Compensationunmatched
- Writing Skillsunmatched
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