Senior Claim Representative
2 days ago
Los Angeles
Job Title: Workers’ Compensation Senior Claim Representative Location: Los Angeles, CA 90071 Duration: 6 Months (Contract to Hire-CTH) Job hours-8:00-4:30 Job schedule-40 hours on site Interview process-WEBEX prescreen/Then in-person interview Job Description: Client is currently seeking a Workers’ Compensation Lost Time Senior Claim Examiner for our West Coast/Pacific region. The successful applicant will be handling claims from California. The position will report and reside in our Los Angeles, CA Duties & Responsibilities: • Handles all aspects of workers’ compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process., • Reviews claim and policy information to provide background for investigation., • Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers., • Evaluates the facts gathered through the investigation to determine compensability of the claim., • Informs insureds, claimants, and attorneys of claim denials when applicable., • Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc., • Timely administration of statutory medical and indemnity benefits throughout the life of the claim., • Sets reserves within authority limits for medical, indemnity and expenses and recommends reserve changes to Team Leader throughout the life of the claim., • Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them., • Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered., • Works with attorneys to manage hearings and litigation, • Controls and directs vendors, nurse case managers, telephonic cases managers and rehabilitation managers on medical management and return to work initiatives., • Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews., • Files workers’ compensation forms and electronic data with states to ensure compliance with statutory regulations., • Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized., • Works with in-house Technical Assistants, Special Investigators, Nurse, • Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service. Technical Skills & Competencies: • Lost Time Claim Examiner position with prior experience in workers’ compensation as a lost time examiner, or similar examiner experience in short-term / long-term disability, auto personal injury protection / medical injury, or general liability claims., • Requires basic knowledge of workers’ compensation statutes, regulations, and compliance., • Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues., • Exceptional customer service and focus., • Ability to openly collaborate with leadership and peers to accomplish goals., • Demonstrates a commitment to a career in claims., • Exceptional time management and multi-tasking capabilities with consistent follow through to meet deadlines., • Use analytical skills to find mutually beneficial solutions to claim and customer issues., • Ability to prepare and make exceptional presentations to internal and external customers., • Conscientious about the quality and professionalism of work product and relationships with co-workers and clients., • Willing to take ownership and tackle obstacles to meet Client's quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation., • Superior verbal and written communication skills. Experience, Education & Requirements: • Experience working in a customer focused, fast-paced, fluid environment, • Experience utilizing strong communication and telephonic skills, • Prior experience requiring a high level of organization, follow-up, and accountability, • Prior workers’ compensation claim handling experience or other similar type of claim handling experience is required (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, or general liability)., • Prior insurance, legal or corporate business experience is a plus but not required, • AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required, • Proficiency with Microsoft Office Products, • Knowledge of medical terminology is required, • Knowledge of bill processing is required, • Certification to handle CA Workers Compensation claims is required, • Experience handling claims in the states of CO, UT, NV and AZ preferred, • If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.