Workers Compensation Claims Examiner

Job Description

Job Description

Job Profile

Job Title

Workers Compensation Claims Examiner (Project 1346011)

Location

Remote reside in California

Hire Type

Contingent

Hourly

$33.65 - $45.00

Work Model

Monday – Friday

Contact Phone

(443)-345-3305

Contact Email

[email protected]

Nature & Scope :

Positional Overview

Mary Kraft is seeking an experienced Workers Compensation Claims Examiner that can analyze and manage complex or technically difficult workers' compensation claims, including indemnity claims, to determine benefits due. This role involves working with high exposure claims that may include litigation and rehabilitation, ensuring timely adjudication in accordance with service expectations, industry best practices, and client requirements. The examiner will be responsible for identifying subrogation opportunities, managing the litigation process, and negotiating settlements to ensure cost-effective claim resolution.

Role & Responsibilit y:

Tasks That Will Lead To Your Success

• Analyze and process complex workers' compensation claims by investigating and gathering relevant information to assess claim exposure.
• Develop action plans to manage claims efficiently and bring them to timely resolution.
• Negotiate claim settlements within designated authority levels.
• Calculate and assign reserves to claims promptly; monitor reserve adequacy throughout the claim lifecycle.
• Calculate benefits due and approve timely claim payments and adjustments; settle claims within authority levels.
• Prepare and submit necessary state filings in compliance with statutory requirements.
• Manage the litigation process to ensure claims are resolved timely and in a cost-effective manner.
• Coordinate vendor referrals for additional investigations or litigation management as necessary.
• Use cost-containment strategies, including partnerships with vendors, to minimize overall claim costs.
• Manage claim recoveries, such as subrogation, Second Injury Fund excess recoveries, and Social Security or Medicare offsets.
• Report claims to excess carriers and respond to requests or directives in a timely and professional manner.
• Maintain clear and regular communication with claimants and clients, ensuring professional relationships are upheld.
• Ensure proper documentation and accurate coding of claim files.
• Refer cases to supervisors and management as needed.
• Perform other duties as assigned.
• Support the organization’s quality initiatives.
• Travel as required.

Skills & Experience:

Qualifications That Will Help You Thrive

• High School Graduate or GED required, Bachelor's degree preferred.
• Professional certifications related to workers' compensation or claims handling preferred.
• Minimum of 5 years of workers' compensation indemnity claims handling experience is required.
• In-depth knowledge of workers' compensation principles, laws, and best practices, including indemnity claims.
• Expertise in litigation management and claims resolution processes.
• Strong understanding of medical management practices, cost-containment techniques, and Social Security/Medicare procedures.
• Excellent oral and written communication skills, including the ability to negotiate and present effectively.
• Proficient in Microsoft Office and claims management software.
• Analytical and problem-solving abilities, with strong organizational skills.
• Ability to work independently and as part of a team.
• Strong interpersonal skills and the ability to meet or exceed service expectations.
• Must reside within California boundaries.
• Minimum of 5 years of experience handling California workers' compensation indemnity claims.
• Strong experience in managing the litigation process to ensure timely, cost-effective claims resolution.
• Credit security clearance, confirmed via a background check, is required.