Adjudication, Alliance/Partner Management, Analysis Skills, Best Practices, Claims Management, Claims Processing, Cost Control, Customer Relations, Customer Support/Service, Data Collection, Develop and Maintain Customers, Licensing, Litigation, Negotiation Skills, Process Analysis, Process Management, SIP (Session Initiation Protocol), State Laws and Regulations, Subrogation, Time Management, Vendor/Supplier Planning, Willing to Travel, Worker's Compensation
Location: Rancho Cucamonga, CA 91730
Duration: 2-3 Months
Description:
Manager's note:
Work location: onsite/hybrid (if residing within 25miles from client office) or remote (within California)
SIP is mandatory. Lost time claims experience.
3 years of relevant and recent worker's comp experience.
PRIMARY PURPOSE: To analyze complex 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 within 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 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.e
eTeam Inc.
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