Finding a Remote job that fits your lifestyle isn’t always easy. That’s where Kelly comes in. We’re seeking a Workers Compensation Claims Examiner to work at a premier client in Pasadena California 91107

Pay rate and shift
Job Duration: 3+ Month
Shift: Mon to Fri Remote

Job Summary:

Job Title: Workers Compensation Claims Examiner
Duration: 3+ Months 
Pay: $50/hr on W2
Location: Remote in CA
Work location: 2923 & 2947 Bradley Street Suites 100 Pasadena California 91107
Shift: 1st Shift (Mon to Fri) 

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.

Additional Functions And Responsibilities

• Performs other duties as assigned.
  

• Supports the organization’s quality program(s).
  

• Travels as required.

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.

Skills & Knowledge:

• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
  

• Excellent oral and written communication, including presentation skills
  

• PC literate, including Microsoft Office products
  

• Analytical and interpretive skills
  

• Strong organizational skills
  

• Good interpersonal skills
  

• Excellent negotiation skills
  

• Ability to work in a team environment
  

• Ability to meet or exceed Service Expectations

Work Environment:

• When applicable and appropriate, consideration will be given to reasonable accommodations. 
  

• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
  

• Physical: Computer keyboarding, travel as required

Note: Must have SIP Certification

What happens next:
Once you apply, you’ll proceed to next steps if your skills and experience look like a good fit. But don’t worry-even if this position doesn’t work
out, you’re still in our network. That means all of our recruiters will have access to your profile, expanding your opportunities even more.
Helping you discover what’s next in your career is what we’re all about, so let’s get to work.
Apply to be a Workers Compensation Claims Examiner today!
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