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Claims Examiner - Workers Compensation

Iconma

Rancho Cucamonga, CA

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JOB DETAILS
SALARY
$45–$50 Per Hour
SKILLS
Adjudication, Alliance/Partner Management, Analysis Skills, Best Practices, Business Solutions, Claims Coding, Claims Management, Claims Processing, Cost Control, Customer Relations, Customer Support/Service, Data Collection, Develop and Maintain Customers, Health Plan, Licensing, Litigation, Medicare, Negotiation Skills, Process Analysis, Process Management, State Laws and Regulations, Subrogation, Time Management, Vendor/Supplier Planning, Worker's Compensation
LOCATION
Rancho Cucamonga, CA
POSTED
3 days ago
Our Client, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation for their Rancho Cucamonga, CA/ Remote within CA location.
 
Responsibilities:
  • 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.
  • 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.
  • Supports the organization's quality program(s).
 
Requirements:
  • 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.
 
Why Should You Apply?#mcb

About the Company

I

Iconma

ICONMA is a global information consulting management firm providing Professional Staffing Services and Project-Based Solutions for organizations in a broad range of industries.

  • Corporate Headquarters in Troy, Michigan; 20+ locations worldwide.
  • Certified Woman-Owned Business Enterprise (WBE); certified by Women’s Business Enterprise National Council, National Women Business Owners Corporation (NWBOC); and California Public Utilities Commission (CPUC).
  • Founded in 2000
  • 2000+ Employees

The company was founded on the principle that success is derived from delivering high quality service and resources in the most responsive, flexible, and innovative way. ICONMA invests in people and resources with a single goal: To provide our customers with the highest quality service in the most responsive manner. Through its network of offices, ICONMA provides the resources to help clients maintain their competitive advantage.

COMPANY SIZE
2,000 to 2,499 employees
INDUSTRY
Management Consulting Services
EMPLOYEE BENEFITS
401K, Employee Referral Program, Life Insurance
FOUNDED
2000
WEBSITE
https://www.iconma.com/