Job Description

This position pays: $32-$52 hourly DOE

Location: Hybrid Granite Bay, CA offices

Workers Comp Claims Examiners

You are a Workers Comp Claims Examiners. In this role you will manage a complex case load with exposures of greater severity including complex legal or medical issues; have a greater reserve and settlement authority, within client restrictions; and uses independent decision making in finding solutions critical for moving claims toward resolution, offering suggestion for improvement and implementing approved solutions. Claims files reflect a lower level of legal involvement and, when counsel is necessary, the Senior Claims Examiner takes on an active role in the litigation process, directing counsel, rather than passively accepting recommendations of counsel.

What you will be doing:

• Evaluate claim and determine course of action from inception to resolution timely and accurately
• Gather and analyze information including medical, legal, and factual evidence to determine compensability of claim
• Evaluate claim to determine appropriate use of independent medical evaluations for claims and/or refer to legal
• Evaluate all information to make appropriate independent determination on compensability and issue compensability decisions
• Manage and direct action of diary, e-mail, mail, faxes, phone calls, payments, required benefit notices, etc. to move claim to the best financial outcome and timely resolution
• Evaluate and establish medical, legal, vocational rehabilitation, and indemnity reserves based on facts of case and full potential exposure including reporting to excess carrier within authority level
• Evaluate and determine an appropriate negotiated settlement amount, within authority level
• Communicate, strategize and direct legal counsel regarding issues such as discovery, depositions, settlement value
• Provide superior claims processing and diary management as exhibited by appropriate reserves, timely payments, reports, contacts, closings and activity on the claim files
• Actively participate in the professional development of other team members by sharing knowledge and best practices through informal and formal training
• Represent the company as needed in depositions, conferences, hearings and trials
• All other duties as assigned or as situation dictates

What you bring:

• High school diploma or G.E.D. required; Bachelor’s degree preferred
• Minimum five (5) years’ experience as a workers’ compensation examiner required
• Strong knowledge of claims management techniques, including investigation, reserving, cost analysis and case resolution techniques
• Strong customer focus with a strong sense of urgency and attention to detail
• Excellent organization skills and demonstrated experience managing multiple simultaneous projects
• Organizational and time management skills related to project management
• Proficient with Microsoft Office and be able to learn and implement specialty software systems and procedures
• Analyze a variety of information to maximize cost-effective claim management
• Discuss claim issues and justify claim reserves
• Anticipate problems and evaluate information to develop and evaluate options and implement solutions
• Communicate effectively, patiently and courteously with employees, Board Members, patrons and other community members and be responsible for protection of patron confidentiality
• Recognize insufficient reserve situations and bring to management’s attention timely
• Manage multiple activities or interruptions at once and to work positively and effectively within a team or self-directed model

Certificate or other Licenses:

• SIP License preferred (senior-level)

To learn more about the workplace culture and the position, apply today!

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