Job Title: Claims Examiner – Workers Compensation
Job Duration: 3-6 months (Possible extension)
Location: Roseville, CA 95661 or Long Beach CA 90806 (Remote)
Shift: M-F
Pay rate: $50/hrs. on W2

Note:
Prefer if someone could be in-office in either Roseville, CA or Long Beach, CA, preferably within driving distance of either office in case it is required for them to come in for a quarterly client meeting and training.

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

• Bachelor’s degree from an accredited college or university preferred.
  

• Professional certification as applicable to line of business preferred.
  

• 5 years of claims management experience or equivalent combination of education and experience required.

Must Have:

• Candidate with prior/current CA Indemnity and Litigated Workers Compensation experience is required.
  

• Self-Insured Plans certification.

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

What happens next: 
Once you apply, you’ll proceed to the 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 our recruiters at Kelly 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 Claims Examiner – Workers Compensation today! 
 
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