Talent.com
Cynet Systems
Claims Examiner - Workers Compensation - Remote / TelecommuteCynet Systems • Pasadena, CA, United States
Claims Examiner - Workers Compensation - Remote / Telecommute

Claims Examiner - Workers Compensation - Remote / Telecommute

Cynet Systems • Pasadena, CA, United States
30+ days ago
Salary
$50.57 hourly
Job type
  • Full-time
Job description

Job Title

Job Overview: Pay Range: $50.57hr - $53.57hr

Responsibilities

  • Analyze and process complex workers compensation claims by investigating and gathering information to determine claim exposure.
  • Manage claims through structured action plans to ensure timely resolution.
  • Negotiate settlement of claims within designated authority limits.
  • Calculate and assign appropriate reserves and manage reserve adequacy throughout claim lifecycle.
  • Calculate and process claim payments, benefits, and adjustments.
  • Prepare required state filings within statutory requirements.
  • Manage litigation process ensuring timely and cost-effective resolution.
  • Coordinate vendor referrals for investigation and litigation management.
  • Apply cost containment strategies to reduce overall claim expenses.
  • Manage claim recoveries including subrogation, Second Injury Fund recoveries, and Social Security/Medicare offsets.
  • Report claims to excess carriers and respond to requests in a timely manner.
  • Communicate claim status with claimants and clients while maintaining professional relationships.
  • Ensure proper documentation and accurate claim coding.
  • Refer cases to supervisor or management as required.
  • Support quality programs and perform additional assigned duties.
  • Travel as required.

Requirements/Must Have

  • Bachelors 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.
  • Strong understanding of insurance principles, laws, recoveries, offsets, and cost containment practices.
  • Strong knowledge of claims handling, disability duration, and medical management practices.

Experience

  • Experience in claims management or related insurance claims processing.
  • Experience handling workers compensation claims preferred.

Should Have

  • Excellent oral and written communication skills.
  • Strong analytical and interpretive abilities.
  • Strong organizational and interpersonal skills.
  • Excellent negotiation skills.
  • Ability to work in a team environment and meet service expectations.

Skills

  • Microsoft Office tools.
  • Claims management systems.
  • Analytical and documentation skills.
  • Insurance and workers compensation knowledge.

Qualification And Education

  • Bachelors degree preferred in related field.
  • Professional certification preferred.
Create a job alert for this search

Claims Examiner - Workers Compensation - Remote / Telecommute • Pasadena, CA, United States

Similar jobs

Claims Examiner - Workers Compensation - Remote / Telecommute

Cynet SystemsOrange, CA, United States
Remote
Full-time

Workers' Compensation Claims Manager.Responsible for analyzing, investigating, and managing complex workers' compensation claims through resolution.Handles claim exposure assessment, reserve manage... Show more

 • Promoted

Workers Compensation Claims Examiner

AcrisureCosta Mesa, CA, United States
Full-time

Workers' Compensation Claims Examiner.A global fintech leader, Acrisure empowers millions of ambitious businesses and individuals with the right solutions to grow boldly forward.Bringing cutting-ed... Show more

 • Promoted

Claims Examiner - Workers Compensation

KellyOrange, CA, United States
Full-time

Claims Examiner Workers Compensation.Finding a remote job that fits your lifestyle isn't always easy.We're seeking a Claims Examiner Workers Compensation to work at a premier client in California... Show more

 • Promoted

Claims Examiner

LanceSoftBrea, CA, United States
Full-time

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 adju... Show more

 • Promoted

Workers Compensation Claims Adjuster II

AS&G Claims AdministrationOrange, CA, United States
Full-time

AvonRisk Claims Management Position.AvonRisk is the nation's leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers' compensation, liability, m... Show more

 • Promoted

Claims Examiner I-III

New Leaf Staffing, Inc.Pasadena, CA, United States
Full-time

Location: Pasadena, CA (Remote/Hybrid available) Schedule: Monday Friday, Full-Time Pay Rate: $20.Employment Type: Long-Term Opportunity Industry: Healthcare / Managed Care / IPA.Job Summary A hea... Show more

 • Promoted • New!

Claims Examiner - Workers Compensation

eTeamOrange, CA, United States
Temporary

Claims Examiner - Workers Compensation.Workers Compensation Claims Examiner (3 years of California WC experience).To analyze complex or technically difficult workers' compensation claims to determi... Show more

 • Promoted

Sr Claim Examiner-WC (CA)

Crawford & CompanyBrea, CA, United States
Full-time

Senior Claims Examiner Workers Compensation (California).We're Hiring: Senior Claims Examiner Workers Compensation (California).This is an exciting opportunity to join a global leader in claims m... Show more

 • Promoted

ADI - Insurance Claim Advocate.

Ally FinancialCosta Mesa, CA, United States
Part-time

Ally Financial only succeeds when its people do - and that's more than some clich people put on job postings.We live this stuff! We see our people as, well, people - with interests, families, frien... Show more

 • Promoted

Claim Examiner- WC

TPI GlobalBrea, CA, United States
Temporary

Remote Note: Must have multiple years' experience handling CA WC.Duties: Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if cov... Show more

 • Promoted

Health Claims Examiner

Ultimate StaffingEl Monte, CA, United States
Full-time

This role is responsible for reviewing, adjudicating, and resolving a variety of healthcare claims while ensuring compliance with benefit plans, policies, and regulatory requirements.The ideal cand... Show more

 • Promoted

WC Examiner - CA

Switch'dBrea, CA, United States
Full-time

Hybrid - 2 days in the office (Brea, California or Las Vegas, NV).Salary $90k-$94k (CA) or $86k-$89k (NV) (pending experience possible negotiation).Bonus of $400 a month w/another bonus in the depa... Show more

 • Promoted

REMOTE Loss Mitigation FHA Claims Specialist

Carrington Holding Company, LLCFullerton, CA, United States
Remote
Full-time

Job Description/h2pCome join our amazing team and work remote from home!/ppThe Loss Mitigation FHA Claims Specialist will be responsible for preparing, filing, and following up on all FHA home rete... Show more

 • Promoted

Workers Compensation Claims Specialist, Disposition

CNABrea, CA, United States
Full-time

You have a clear vision of where your career can go.And we have the leadership to help you get there.At CNA, we strive to create a culture in which people know they matter and are part of something... Show more

 • Promoted

Claims Examiner

E-talentnetworkWhittier, CA, United States
Full-time

Location: 9557 Greenleaf Avenue, Whittier, CA.Shift: Monday - Friday - 07:00am - 03:30pm.Please Note Orientation Time May Differ Than Shift Times Listed Duration - 13 weeks ***. Show more

 • Promoted

Claim Examiner- WC

Abacus Service CorporationBrea, CA, United States
Full-time

Are you ready to take your career to the next level in a vibrant and thriving community? Join us in Brea, California, where you'll enjoy a dynamic work environment and the chance to make a signific... Show more

 • Promoted

Senior Claims Specialist- Workers' Compensation

BITCO Insurance CompaniesPasadena, CA, United States
Full-time

Senior Claims Specialist, Workers' Compensation.BITCO Corporation is seeking a Senior Claims Specialist, Workers' Compensation to join our regional office located in Pasadena, CA.As a respected spe... Show more

 • Promoted

Technical Claims Specialist, Workers Compensation - West Region

Liberty Mutual Insurance GroupOrange, CA, United States
Full-time

Complex Workers Compensation Investigator.Under limited supervision and established practices, responsible for the investigation, evaluation, and disposition of complex workers compensation cases o... Show more

 • Promoted

Workers Compensation Claims Supervisor

Intercare InsuranceOrange, CA, United States
Full-time

Workers Compensation Claims Supervisor/h2pWere seeking an experienced and motivated Workers Compensation Claims Supervisor to join our team in Orange, CA.As a Supervisor, youll lead a team of 8, in... Show more

 • Promoted

Claims Examiner - Workers Compensation

MindlanceOrange, CA, United States
Full-time

Workers Compensation Claims Examiner.Preferred SIP Certification Medical facilities.PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits d... Show more