Claims Examiner - Workers Compensation
Apply NowCompany: Cynet Systems
Location: Ontario, CA 91761
Description:
Job Description:
Pay Range: $65hr - $70hr
Responsibilities:
Pay Range: $65hr - $70hr
Responsibilities:
- nalyzes and processes complex 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 within 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 within designated authority level.
- Prepares necessary state fillings within 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 Social Security and Medicare offsets.
- Reports claims to the excess carrier; 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.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
- Education & Licensing-Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- Experience-Five (5) years of claims management experience or equivalent combination of education and experience required.
- 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 Social Security and Medicare application procedures as applicable to line-of-business.
- Excellent oral and written communication, including presentation skills.
- PC literate, including Microsoft Office products.
- nalytical and interpretive skills.
- Strong organizational skills.
- Good interpersonal skills.
- Excellent negotiation skills.
- bility to work in a team environment.
- bility to meet or exceed Service Expectations.