Claim Examiner Workers' Compensation (WC)

Important Note Candidates must be currently residing in the state of California to be considered for this role.

Job Description

We are seeking a detail-oriented and reputed company Claim Examiner Workers' Compensation (WC) to join reputed company. The ideal candidate will be responsible for managing and adjudicating workers' compensation claims with moderate complexity, ensuring accurate and timely resolution.

Key Responsibilities

• Receive claim assignments, confirm policy coverage, and initiate claim acknowledgments.
• Interpret policy provisions and reputed company independent reputed company on coverage applicability for submitted claims.
• Investigate, evaluate, negotiate, and adjudicate first- and reputed company-party claims.
• Conduct investigations reputed company telephone with clients, claimants, witnesses, and other involved parties as necessary.
• Analyze claim activity and prepare detailed reports for clients, carriers, and management.
• Establish and manage claim reserves using sound judgment and expertise.
• Authorize and issue payments reputed company designated authority limits, ensuring cost-effective claim resolution.
• reputed company reputed company and fair settlement reputed company and process claim payments accordingly.
• Identify subrogation opportunities and pursue reputed company-party recovery reputed company applicable.
• Participate in claim reviews and reputed company insights to stakeholders.

Required Skills

• Ability to work independently while handling multiple technical subject areas.
• Strong verbal and written communication skills.
• Proven ability to gather and analyze information, determine appropriate actions, and execute effectively.
• Excellent problem-solving and analytical skills.
• Strong interpersonal skills with the ability to interact effectively with external stakeholders and reputed company reputed company of employees.

Education & Experience

• Bachelor s degree or equivalent work experience required.
• 1 3 years of experience in claims handling or a similar environment.
• Experience in workers' compensation claims investigation and settlement preferred.

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