ICONMA
Our Client, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation for their Rancho Cucamonga, CA/Remote location.
Responsibilities:
- Analyze complex or technically difficult workers' compensation claims to determine benefits due; work with high exposure claims involving litigation and rehabilitation; ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; identify subrogation of claims and negotiate settlements.
- Investigate and process complex or technically difficult workers' compensation claims by gathering information to determine exposure; manage claims through well-developed action plans for timely resolution.
- Negotiate settlement of claims within designated authority.
- Calculate and assign appropriate reserves; manage reserve adequacy throughout the claim's lifecycle.
- Calculate and pay benefits due; approve and process claim payments and adjustments; settle claims within authority level.
- Prepare necessary state filings within statutory limits.
- Manage litigation processes; ensure timely and cost-effective resolution.
- Coordinate vendor referrals for investigation and litigation management.
- Use cost containment techniques, including strategic vendor partnerships, to reduce overall claim costs.
- Manage claim recoveries, including subrogation, Second Injury Fund recoveries, and Social Security and Medicare offsets.
- Report claims to excess carriers; respond to requests promptly and professionally.
- Communicate claim activity with claimants and clients; maintain professional relationships.
- Ensure proper documentation and accurate claim coding.
- Refer cases to supervisors or management as appropriate.
- Perform other duties as assigned.
- Support the organization's quality programs.
Requirements:
- Bachelor's degree from an accredited college or university preferred; professional certification as applicable.
- Five (5) years of claims management experience or equivalent.
- Expertise in insurance principles, laws, recoveries, claim and disability management, and cost containment principles.
- Excellent communication, presentation, and PC skills, including Microsoft Office.
- Strong analytical, organizational, interpersonal, and negotiation skills.
- Ability to work in a team and meet service expectations.
- Consideration for reasonable accommodations when applicable.
- Clear conceptual thinking, judgment, problem-solving, stress management, and multitasking abilities.
- Physical requirement: computer keyboarding.
Why Should You Apply?
- Health Benefits
- Referral Program
- Opportunities for growth and advancement
As an equal opportunity employer, ICONMA supports and encourages diversity in the workplace, respecting all characteristics protected by law.
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