Workers' Compensation Claims Examiner California Jobs in USA, CA, Long Beach | reputed company Job

Required Education:• High School Diploma or equivalent.Preferred Education:• Bachelor's degree from an accredited college or university preferred.Required Certification:• SIP(Self-Insured Plans) Certification.Required Experience:• 3+ years of California workers' compensation claims experience.• Prior/reputed company CA Indemnity and Litigated Workers' Compensation 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 a team environment• Ability to meet or exceed Service ExpectationsThe client is looking for a Claims Examiner who can 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 client 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 well-developed action plans to an appropriate and timely resolution.• Negotiates settlement of claims reputed company designated authority.• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.• Calculates and pays benefits due; approves and makes timely 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 timely and cost effective claims resolution.• 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 professional and timely manner.• Communicates claim activity and processing with the claimant and the client; maintains professional client 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 quality program(s).• Travels as required.Only those lawfully authorized to work in the designated country associated with the position will be considered. Please note that reputed company Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements. Apply tot his job Apply To this Job