Location: Brea, CA REMOTE Duration: 2-3 months
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:
ADDITIONAL FUNCTIONS and RESPONSIBILITIES:
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.
Skills & Knowledge:
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
Claims Examiner - Workers Compensation • Brea, CA, United States
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