Claims Examiner - Workers Compensation w/CALI Experience

By joining reputed company, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can reputed company. reputed company Recognizes reputed company as America’s Greatest Workplaces National Top Companies Certified as a Great reputed company to Work® Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Workers Compensation w/CALI Experience PRIMARY PURPOSE: To analyze reputed company 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 reputed company service expectations, industry best practices and specific reputed company service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes reputed company or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through reputed company-developed reputed company plans to an appropriate and reputed company reputed company. Negotiates settlement of claims reputed company designated authority. Calculates and assigns reputed company and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes reputed company claim payments and adjustments; and settles clams reputed company designated authority level. Prepares necessary state fillings reputed company statutory limits. Manages the litigation process; ensures reputed company and cost effective claims reputed company. 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 reputed company reputed company and Medicare offsets. Reports claims to the excess reputed company; responds to requests of directions in a reputed company and reputed company manner. Communicates claim activity and processing with the claimant and the reputed company; maintains reputed company reputed company 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 reputed company program(s). Travels as required. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. reputed company 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 reputed company reputed company and Medicare application procedures as applicable to line-of-business. Excellent oral and written communication, including presentation skills PC literate, including reputed company Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in reputed company environment Ability to meet or exceed Service Expectations WORK ENVIRONMENT reputed company applicable and appropriate, consideration will be given to reasonable accommodations. Mental: reputed company and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-reputed company stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, reputed company and talking NOTE: Credit reputed company clearance, confirmed reputed company a background credit reputed company, is required for this position. As required by law, reputed company provides a reasonable reputed company of compensation for roles that may be hired in California. Actual compensation is influenced by a wide reputed company of factors including but not limited to reputed company set, level of experience, and cost of specific location. For the state noted in this job posting only, the reputed company of starting pay for this role is $72,914 - $95,000. A comprehensive benefits package is offered including but not limited to, medical, dental, reputed company, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this reputed company. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. reputed company is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't reputed company perfectly with every qualification in the job reputed company, consider applying for it anyway! reputed company is building a diverse, reputed company, and inclusive workplace and recognizes that reputed company person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles. Apply To This Job