Cynet systems Inc
Claims Examiner - Workers Compensation - Remote / Telecommute
Cynet systems Inc, Orange, California, United States, 92613
Job Description: Pay Range: $47hr - $52hr
Responsibilities
Analyze and process complex or technically challenging workers’ compensation claims.
Investigate claims and gather information to determine exposure and develop action plans for timely resolution.
Negotiate settlements within the designated authority.
Calculate, assign, and manage reserves throughout the life of claims.
Approve and make timely benefit payments and claim adjustments.
Please prepare necessary state filings within the minimum limits.
Manage litigation processes to ensure cost-effective and timely claim resolution.
Coordinate vendor referrals for investigation or litigation management.
Apply cost containment techniques, including vendor partnerships, to reduce overall claim costs.
Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security/Medicare offsets.
Report claims to excess carriers and respond to inquiries professionally and promptly.
Communicate claim activity and status with claimants and clients while maintaining professional relationships.
Please make sure claim files are properly documented and accurately coded.
Refer cases to supervisors or management as appropriate.
Perform additional duties as assigned and support organizational quality programs.
Travel as required for claims management.
Requirements
Five years of claims management experience or equivalent combination of education and experience.
Knowledge of workers’ compensation insurance principles, laws, recoveries, offsets, and deductions.
Understanding of cost containment practices, medical management, and Social Security/Medicare procedures.
Excellent oral and written communication, including presentation skills.
Strong analytical, interpretive, and organizational skills.
Proficiency with Microsoft Office applications.
Strong interpersonal skills and ability to work effectively in a team.
Excellent negotiation skills.
Preferred Qualifications
Bachelor’s degree from an accredited college or university.
Professional certification relevant to workers’ compensation or claims management.
Education
Bachelor’s degree preferred; professional certification preferred.
Experience
Minimum 5 years of claims management experience.
Skills
Analytical and problem-solving skills.
Communication and negotiation skills.
Organizational and time management skills.
PC literacy, including Microsoft Office.
Work Environment
Ability to handle multiple priorities and work under pressure.
Travel as required.
Reasonable accommodations will be considered when applicable.
Physical/Mental Requirements (Due to the nature of the job)
Computer keyboarding, vision, hearing, and verbal communication.
Strong judgment, conceptual thinking, and discretion.
Ability to meet deadlines and handle work-related stress.
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Responsibilities
Analyze and process complex or technically challenging workers’ compensation claims.
Investigate claims and gather information to determine exposure and develop action plans for timely resolution.
Negotiate settlements within the designated authority.
Calculate, assign, and manage reserves throughout the life of claims.
Approve and make timely benefit payments and claim adjustments.
Please prepare necessary state filings within the minimum limits.
Manage litigation processes to ensure cost-effective and timely claim resolution.
Coordinate vendor referrals for investigation or litigation management.
Apply cost containment techniques, including vendor partnerships, to reduce overall claim costs.
Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security/Medicare offsets.
Report claims to excess carriers and respond to inquiries professionally and promptly.
Communicate claim activity and status with claimants and clients while maintaining professional relationships.
Please make sure claim files are properly documented and accurately coded.
Refer cases to supervisors or management as appropriate.
Perform additional duties as assigned and support organizational quality programs.
Travel as required for claims management.
Requirements
Five years of claims management experience or equivalent combination of education and experience.
Knowledge of workers’ compensation insurance principles, laws, recoveries, offsets, and deductions.
Understanding of cost containment practices, medical management, and Social Security/Medicare procedures.
Excellent oral and written communication, including presentation skills.
Strong analytical, interpretive, and organizational skills.
Proficiency with Microsoft Office applications.
Strong interpersonal skills and ability to work effectively in a team.
Excellent negotiation skills.
Preferred Qualifications
Bachelor’s degree from an accredited college or university.
Professional certification relevant to workers’ compensation or claims management.
Education
Bachelor’s degree preferred; professional certification preferred.
Experience
Minimum 5 years of claims management experience.
Skills
Analytical and problem-solving skills.
Communication and negotiation skills.
Organizational and time management skills.
PC literacy, including Microsoft Office.
Work Environment
Ability to handle multiple priorities and work under pressure.
Travel as required.
Reasonable accommodations will be considered when applicable.
Physical/Mental Requirements (Due to the nature of the job)
Computer keyboarding, vision, hearing, and verbal communication.
Strong judgment, conceptual thinking, and discretion.
Ability to meet deadlines and handle work-related stress.
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