What are the responsibilities and job description for the Claims Examiner - Workers Compensation position at eTeam, Inc.?
Job Title : Claims Examiner - Workers Compensation
Location : Long Beach / Roseville CA
Duration : Full-Time / Direct Hire
Description : Manager's note :
SIP - preferred
Relevant years of experience : 10 years of WC claims experience.
Onsite role - all 5 days office
Office location : 1st preference is Roseville and 2nd would be Long beach, CA.
Experience : indemnity & litigation experience is must.
PRIMARY PURPOSE :
To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
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 settlement of claims within 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 fillings 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 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 of 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 supervisor and management.
QUALIFICATION :
Education & Licensing
Bachelor's degree from an accredited college or university preferred.
Professional certification as applicable to line of business preferred.
Experience :
Five (5) years of claims management experience or equivalent combination of education and experience required.
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