Job description

Requirements

  • Entry level
  • No Education
  • Salary to negotiate
  • Concord

Description

Claims Examiner Senior (WC)

Acclamation InsuranceManagement Services (AIMS)– Concord , CA

Job Description

The Senior Workers’ Compensation Examiner isresponsible for the analysis and management of complex workers’ compensationclaims. This position will review, investigate, and make decisions regardingcoverage, compensability, and appropriateness of claims. The position willprocess and document claims to ensure compliance with company standards,industry best practices, and legislative provisions. Acts in a fiduciary roleon behalf of policyholders, negotiates claim settlements and managessubrogation. Senior Claims Examiner’s conduct the handling of claims in theutmost of good faith in compliance with the rules, regulations and statutes ofthe WCAB and State of California. The Senior Workers’ Compensation Examiner isexpected to function with a degree of competency. The use of sound judgmentcoupled with consistent results is expected.

RESPONSIBILITIES:


- Analyzes and processesworkers’ compensation claims by investigating and gathering information todetermine the exposure on the claim.
- Negotiates settlement ofclaims up to designated authority level and makes claims payments.
- Processes complex ortechnically difficult claims.
- Calculates and assignstimely and appropriate reserves to claims and continues to manage reserveadequacy throughout the life of the claim. • Calculates and pays benefits due;approves all claim payments; and settles claims within designated authoritylevel.
- Develops and managesclaims through well-developed action plans; continues to work the action planto bring the claim to an appropriate and timely resolution.
- Prepares necessary statefilings within statutory limits.
- Actively manages thelitigation process; ensures timely and cost-effective claims resolution.
- Coordinates vendorreferrals for additional investigation and/or litigation management.
- Uses appropriate costcontainment techniques including strategic vendor partnerships to reduceoverall cost of claims.
- Manages claim recoveriesof all types, including but not limited to subrogation, Second Injury Fundrecoveries, and Social Security offsets.
- Reports claims to theexcess carrier, responds to requests of directions in a professional and timelymanner.
- Frequently communicateswith all appropriate parties involved with the claim.
- Refers cases asappropriate to management.
- Maintains professionalclient relationships.
- Actively executesappropriate claims activities to ensure consistent delivery of quality claimsservice. REQUIREMENTS: · 5+ years claims management experience. ·In depth knowledge of appropriate insurance principles and laws for workers’compensation. · Strong written and verbal communication skills. · Strongorganizational skills. · Strong negotiation skills · Strong analytical andinterpretive skills. · PC literate. · Baccalaureate degree from an accreditedcollege or university preferred. · Professional certification (SIP) asapplicable to workers’ compensation required.

Job Type: Full-time

Local candidates only:


- Sacramento, CA Required experience:


- 5+ years claimsmanagement experience: 5 years Required license or certification:


- California DriversLicense Required education:


- Bachelor's

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