Workers' Compensation Senior Claim Representative
ASB Resources, Los Angeles, California, United States, 90079
Job Description: Our company 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. • 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 andrelationships with co-workers and clients. • Willing to take ownership and tackle obstacles to meet company 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.
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. • 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 andrelationships with co-workers and clients. • Willing to take ownership and tackle obstacles to meet company 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.