Remote Claims Examiner- Workers Compensation

October 10, 2024

Industry: Private

Employment Type:- Full Time

Work Hours:- 8 Hours

Locations:- USA

Full Job Description:-

Description

We're looking for a Remote Claims Examiner- Workers Compensation, working in the Insurance industry in Pasadena, California, United States.

Work location: Remote in CA

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Analyze complex or technically difficult workers' compensation claims to determine benefits due.
Work with high exposure claims involving litigation and rehabilitation.
Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements.
Identify subrogation of claims and negotiate settlements.
Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
Manage claims through well-developed action plans to an appropriate and timely resolution.
Negotiate settlement of claims within designated authority.
Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
Calculate and pay benefits due; approve and make timely claim payments and adjustments; and settle claims within designated authority level.
Prepare necessary state fillings within statutory limits.
Manage the litigation process; ensure timely and cost-effective claims resolution.
Coordinate vendor referrals for additional investigation and/or litigation management.
Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
Manage claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Report claims to the excess carrier; respond to requests of directions in a professional and timely manner.
Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
Ensure claim files are properly documented and claims coding is correct.
Refer cases as appropriate to supervisor and management.
Support the organization's quality program(s).
Perform other duties as assigned.

Experience Required for Your Success

Bachelor's degree from an accredited college or university preferred
Professional certification as applicable to line of business preferred
5 years of claims management experience or equivalent combination of education and experience required
Workers Compensation Claims Examiner (3+ years of California WC experience)
Must have SIP Certification
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
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 Expectations
When applicable and appropriate, consideration will be given to reasonable accommodations.
Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Company Description

Kelly Services has provided workforce solutions to customers in a variety of industries throughout its history. Kellys range of workforce solutions and geographic coverage has grown steadily over the years to match the needs of our customers. Kellys traditional expertise began with office services, call center, light industrial, and electronic assembly staffing. Today, Kelly also offers a comprehensive array of outsourcing and consulting services for its customers, including recruitment, human resource management, vendor management, and outplacement services on a global basis.

Kelly has evolved from a United States-focused company concentrating primarily on traditional office services into a global workforce solutions leader with a breadth of specialty businesses. Kelly assigns professional and technical employees in the fields of finance and accounting, education, engineering, information technology, law, science, and healthcare. Kelly is the worlds largest scientific staffing provider and it ranks among the leaders in IT, engineering, and financial staffing.