JOB SUMMARY: This position can be hybrid
Investigates, evaluates, disposes and settles moderately complex to complex/high exposure claims. Includes the investigation, evaluation and determination of coverage, compensability and responsibility and the setting of proper reserves.

DUTIES AND RESPONSIBILITIES:

• Processes moderately complex to complex or high exposure claims consistent with clients’ and corporate policies, procedures and “Best Practices” and in accordance with any statutory, regulatory and ethics requirements.
• Independently analyzes claim exposure, determines a proper plan of action to appropriately mitigate and settle/close the claim working within established level of authority.
• Interacts with injured workers, client contacts and attending Physician(s) to ensure awareness and understanding of the Workers’ Compensation process, requirements and entitlements.
• Interacts with disability and leave examiners’ for coordination of non occupational benefits.
• Prepares and issues notices in accordance with mandated requirements and regularly reviews and stays abreast of applicable laws, rules and regulations that may impact how claims are processed.
• Establishes and maintains proper reserving throughout the life of the claim.
• Identify subrogation potential and pursue the process for reimbursement.
• Complies with carrier excess reporting and threshold requirements.
• Coordinates medical treatment for injured workers and provides information to treating physician(s) regarding the employee’s medical history, health issues and job requirements.
• Fully understands Medicare reporting requirements as they relate to a Workers’ Compensation claim.
• Facilitates early RTW through temporary, transitional, alternate, or modified work.
• Manages all medical aspects of a claim file with a focus on RTW and end of treatment.
• Refers appropriate files for task management assignments to approved vendors for medical management, special investigative needs, conditional payments, etc. up to assigned authority.
• Monitors status and quality of work performed.
• Serves as a liaison between medical providers, employees, legal professionals, clients and vendors.
• Independently manages claims in litigation with regular and consistent communication with defense counsel to make recommendations and develop strategy.
• Enters and maintains accurate information in the claims management computer system.
• Clearly communicates concise action plans and present plans for moving the claim to resolution.
• Meets with clients to discuss on-going claims or review open claim inventory.
• Effectively controls expenses on all Workers’ Compensation claims.
• Mentors first level WC Examiners.
• All other duties as assigned.

EQUIPMENT OPERATED/USED: Computer, fax machine, copier, printer and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire.
QUALIFICATIONS REQUIRED:

Education: High School Diploma or GED required: Bachelor’s degree in related field (strongly preferred) or equivalent combination of education and experience.

Experience: Three (3) to five (5) years of Workers’ Compensation Claims administration experience required working with self-insured and/or insured claims.
Preferred Skills:

• Demonstrated experience working with complex, high exposure and litigated WC claims.
• Appropriately licensed and/or certified in all States in which claims are being handled. Multi-Jurisdiction experience is a ( ).
• Bilingual Spanish is a ( )
• Able to work in a fast paced, high stress, changing environment.
• Strong analytical, critical thinking and problem solving skills required.
• Effective verbal and written communication skills required.
• Excellent planning, organizing and negotiation skills required.
• Attention to detail.
• Negotiation and interpretive skills necessary.
• Demonstrated knowledge of established claims strategy and mitigation techniques.
• Establishes and maintains effective working relationships with those contacted in the course of work.
• Proficiency with computers and technology – working knowledge of Microsoft Office application suite (MS Word, Excel, etc. and familiarity and experience using standard claims administration applications.
• Good interpersonal skills with an ability to work within a team environment.
• Able to effectively handle multiple priorities simultaneously.
• Works independently.
• Possesses CA SIP License

Location: 2325 Clayton Road, Concord, CA 94520

Job Type: Full-time

Pay: $90,000.00 - $95,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Work setting:

• Hybrid work

Work Location: Hybrid remote