Date Posted: December 12, 2017
Job Type: Direct Hire
Job ID: 292216
Senior Workers’ Compensation Claims Examiner
Our client, a reputable insurance organization with offices throughout the nation has several opening in its Fresno office. It has recently been awarded a very large account and are in need of talented examiners to take part in this exciting opportunity. This company offers tremendous flexibility and understands the importance of work-life balance. So much so, that when you work for them, in addition to the vacation time, employees get the option to take every other Friday off! If you live in an area outside of Fresno the company is willing to consider work from home opportunities for qualified candidates with the right experience.
This company has been around for over 40 years and continues to grow year after year, thus offering several opportunities for professional development and advancement. The Senior Claims Examiner will work independently to manage workers’ compensation cases and is responsible for managing complex legal issues, litigation prevention and control, negotiation of settlements, lien resolutions and cost containment.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Investigate and process workers’ compensation claims by examining and gathering information to determine the exposure on the claim
- Negotiate settlement of claims up to designated authority level and makes claims payments
- Processes claims of various complexities
- Develop and manage claims through well-developed action plans and continue to work the action plan to bring the claim to an appropriate and timely resolution
- Calculate and assign timely and appropriate reserves to claims while continuing to manage reserve adequacy throughout the life of the claim and evaluate and determines the appropriate reserve of assigned cases for future liability
- Prepare necessary state filings within statutory limits
- Actively manage the litigation process and ensure timely and cost-effective claims resolution
- Coordinate vendor referrals for additional investigation and/or litigation management
- Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims
- Manage claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets
- Actively execute appropriate claims activities to ensure consistent delivery of quality claims service
- Inform all parties, both external and internal, of status of claim
- Promote litigation avoidance through close contact with injured worker to assure complete understanding of claims process and benefits integration
- Provide technical support and guidance to the claims staff on medical only and workers’ compensation indemnity claims
- Act as company witness at WCAB hearings
- Accurately apply state law to administer workers’ compensation claims in accordance with all rules, regulations and reporting requirements of the Labor Code, division of Workers compensation, Self-Insurance Regulations and other administrative laws
- Develop and document plan to resolve cases
- Identify and investigates questionable cases, third party, fraud and abuse
- Direct attorneys for cost effective case resolution
- Review and approve benefits payable to injured worker, invoices including attorney bills, medical provider bills, liens and mileage
- Rate injured workers permanent disability
- Minimum of 3 years of workers’ compensation claims experience
- Self-Insurance Certificate required
- WCCA and/or WCCP preferred and must be Current on Worker’s Compensation education training hours
- Litigated and non-litigated claims experience required
- Knowledge and understanding of workers’ compensation claims administration required
- Basic mathematical skills required for calculations and ratings
- Thorough knowledge of Self-Insurance regulations, Case Law, Labor Code
- Must possess strong time management, organization and problem solving skill
- Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents
- Ability to write letters, memos and reports that conform to prescribed style, format and grammatical correctness. Ability to effectively present information to top management
- Extensive clear and tactful communications required via writing, reading, telephone calls, note taking, letter writing, memoranda, etc.
- Strong negotiation skills
Compensation and Benefits
- Competitive salary depending on experience level
- Exceptional time off package; every other Friday off, 9 paid holidays, paid vacation time off with separate sick time
- Medical benefits; Medical, dental and vision with 3 carrier/plan options, partially paid for by employer plus employer contributes to an HSA
Why Insurance Relief™?
As a businessperson in the insurance industry, it is an advantage to partner with a staffing expert and ally who understands your unique skills and needs. With vast experience in the insurance arena, Insurance Relief™ works with brokers, carriers and third party administrators to locate and place the best people for positions ranging from entry level to senior management. We invest the time to truly understand what you want to accomplish, and then do our best to find meaningful opportunities.
Insurance Relief™ provides ample opportunities for you to put your skills to work so if this position is not quite the fit for you please give us a call to hear about all of the other opportunities we have available.
Contact us today! firstname.lastname@example.org, 888-292-4440