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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
2 days ago
Salary
$50.57 hourly
Job type
  • Full-time
Job description

Job Title

Pay Range: $45hr - $50hr

Requirement/Must Have:

  • 3+ years of California WC experience.
  • SIP Certification.
  • Credit security clearance, confirmed via a background credit check.

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 claims within designated authority level.
  • Prepares necessary state filings 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.
  • 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.

Nice to Have:

  • Supports the organization's quality program(s).
  • Travels as required.

Education and Experience:

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

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