Claims Examiner - Workers Compensation



BCforward is currently seeking a highly motivated Claims Examiner - Workers Compensation
for an opportunity in Remote!




Position Title: Claims Examiner - Workers Compensation




Location: Remote (California-based)




Expected Duration: 3 months




Job Type: FULL TIME (>=30 HRS WEEKLY, [CONTRACT], [REMOTE]




Pay Range:$45.00




Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).




**PRIMARY PURPOSE:**

To analyze complex or technically difficult workers' compensation claims, determine benefits due, and 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.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES:**


- Analyze and process complex workers' compensation claims by investigating and gathering information to determine exposure, manage claims, and resolve them in a timely manner.
- Negotiate settlement of claims within designated authority.
- Assign and manage appropriate reserves for claims; ensure reserve adequacy throughout the life of each claim.
- Calculate and pay benefits due; approve claim payments and adjustments; settle claims within authority level.
- Prepare necessary state filings within statutory limits.
- Manage litigation process; ensure claims are resolved in a timely and cost-effective manner.
- Coordinate vendor referrals for additional investigation or litigation management.
- Use cost containment techniques and strategic vendor partnerships to reduce overall claim costs for clients.
- Manage claim recoveries including subrogation, Second Injury Fund excess recoveries, and Social Security/Medicare offsets.
- Report claims to the excess carrier and respond to requests promptly.
- Maintain communication with claimants and clients, providing updates and ensuring professional relationships.
- Ensure claims files are properly documented, and claims coding is accurate.
- Refer complex cases to supervisor or management as needed.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES:**


- Perform other duties as assigned.
- Support the organization's quality program(s).
- Travel as required.

**QUALIFICATIONS:**


**Education & Licensing:**

- Bachelor's degree preferred, or equivalent combination of education and experience.
- Professional certification, such as SIP (Self-Insured Plans) certification, preferred.

**Experience:**

- A minimum of 5 years of claims management experience or equivalent combination of education and experience.
- Experience with California Workers' Compensation claims is required.

**Skills & Knowledge:**

- Expert knowledge of insurance principles and laws relevant to workers' compensation claims, cost containment, and recoveries.
- Strong understanding of claim and disability duration, medical management practices, and Social Security/Medicare application procedures.
- Excellent oral and written communication skills, including presentations.
- Proficient in Microsoft Office Suite.
- Strong analytical and interpretive skills.
- Ability to organize and prioritize work effectively.
- Excellent interpersonal and negotiation skills.
- Ability to work independently and as part of a team.
- Ability to meet or exceed service expectations.

**ADDITIONAL NOTES:**


- Credit security clearance required, confirmed via background check.
- This position is remote within California.
- Public entity experience is preferred.
- High School Diploma or equivalent required.




Benefits:




BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.





About BC
forward
:




Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.




BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.




BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.




To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.




This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.








Interested candidates please send resume in Word format Please reference job code 231598 when responding to this ad.


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Job Snapshot




Employee Type

Contractor



Location

Orange, CA (Onsite)



Job Type

Insurance



Experience

Not Specified



Date Posted

11/20/2024