Claims Examiner - Workers Compensation

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Our client is currently seeking a Claims Examiner - Workers' Compensation Job location:  San Diego, CA (Onsite) Any specific skill/ certification/ license: CA license Years of experience:  3+years of relevant WC claims experience ESSENTIAL FUNCTIONS and 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 the settlement of claims within the 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 filings 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 the 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 for 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 the supervisor and management.
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Location:
San Diego

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