Claims Examiner - Workers Compensation - Apidel Technologies

Description:

Manager\'s notes:

Work address: 8855 Haven Ave., Rancho Cucamonga, CA 91730

Job location: remote or onsite we are open to eitheroption.

Any specific skill/ certification/ license: Self insuredcertificate, experience handling public entities

Years of experience: at least 4 years

Candidate should be local to CA only.

PRIMARY PURPOSE: To analyze complex or technicallydifficult workers\' compensation claims to determine benefits due; to work withhigh exposure claims involving litigation and rehabilitation; to ensure ongoingadjudication of claims within service expectations, industry best practices andspecific client service requirements; and to identify subrogation of claims andnegotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Analyzes and processes complex or technically difficultworkers\' compensation claims by investigating and gathering information todetermine the exposure on the claim; manages claims through well-developedaction plans to an appropriate and timely resolution.

Negotiates settlement of claims within designatedauthority.

Calculates and assigns timely and appropriate reserves toclaims; manages reserve adequacy throughout the life of the claim.

Calculates and pays benefits due; approves and makestimely claim payments and adjustments; and settles clams within designatedauthority level.

Prepares necessary state fillings within statutorylimits.

Manages the litigation process; ensures timely and costeffective claims resolution.

Coordinates vendor referrals for additional investigationand/or litigation management.

Uses appropriate cost containment techniques includingstrategic 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 andMedicare offsets.

Reports claims to the excess carrier; responds torequests of directions in a professional and timely manner.

Communicates claim activity and processing with theclaimant and the client; maintains professional client relationships.

Ensures claim files are properly documented and claimscoding is correct.

Refers cases as appropriate to supervisor and management.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

Supports the organization\'s quality program(s).

Travels as required.

QUALIFICATION

Education & LicensingBachelor\'s degree from anaccredited college or university preferred. Professional certification asapplicable to line of business preferred.

ExperienceFive (5) years of claims management experienceor equivalent combination of education and experience required.

Skills & Knowledge

Subject matter expert of appropriate insurance principlesand laws for line-of-business handled, recoveries offsets and deductions, claimand disability duration, cost containment principles including medicalmanagement practices and Social Security and Medicare application procedures asapplicable to line-of-business.

Excellent oral and written communication, includingpresentation 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 givento reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellentjudgment, troubleshooting, problem solving, analysis, and discretion; abilityto handle work-related stress; ability to handle multiple prioritiessimultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE: Credit security clearance, confirmed via abackground credit check, is required for this position.

The statements contained in this document are intended todescribe the general nature and level of work being performed by a colleagueassigned to this description. They are not intended to constitute acomprehensive list of functions, duties, or local variances. Management retainsthe discretion to add or to change the duties of the position at any time.

Requirements:

Manager\'s notes:

Work address: 8855 Haven Ave., Rancho Cucamonga, CA 91730

Job location: remote or onsite we are open to eitheroption.

Any specific skill/ certification/ license: Self insuredcertificate, experience handling public entities

Years of experience: at least 4 years

Candidate should be local to CA only.