Workers' Compensation Senior Claim Representative
USA Jobs, Los Angeles, California, United States, 90079
Workers' Compensation Senior Claim Representative
Our client, a Property and Casualty Insurance company, is looking for a Workers' Compensation Senior Claim Representative for their Los Angeles, CA location. Responsibilities include: Handling all aspects of workers' compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process. Reviewing claim and policy information to provide background for investigation. Conducting 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers. Evaluating the facts gathered through the investigation to determine compensability of the claim. Informing insureds, claimants, and attorneys of claim denials when applicable. Preparing 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. Setting reserves within authority limits for medical, indemnity and expenses and recommending reserve changes to Team Leader throughout the life of the claim. Reviewing the claim status at regular intervals and making recommendations to Team Leader to discuss problems and remedial actions to resolve them. Preparing and submitting to Team Leader unusual or possible undesirable exposures when encountered. Working with attorneys to manage hearings and litigation. Controlling and directing vendors, nurse case managers, telephonic case managers and rehabilitation managers on medical management and return to work initiatives. Complying with customer service requests including Special Claims Handling procedures, file status notes and claim reviews. Filing workers' compensation forms and electronic data with states to ensure compliance with statutory regulations. Referring appropriate claims to subrogation and securing necessary information to ensure that recovery opportunities are maximized. Working 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. Requirements include: 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 and relationships with co-workers and clients. Willing to take ownership and tackle obstacles to meet client quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation. Superior verbal and written communication skills. 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 types 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. Why Should You Apply? Health Benefits Referral Program Excellent growth and advancement opportunities As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or expression, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
Our client, a Property and Casualty Insurance company, is looking for a Workers' Compensation Senior Claim Representative for their Los Angeles, CA location. Responsibilities include: Handling all aspects of workers' compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process. Reviewing claim and policy information to provide background for investigation. Conducting 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers. Evaluating the facts gathered through the investigation to determine compensability of the claim. Informing insureds, claimants, and attorneys of claim denials when applicable. Preparing 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. Setting reserves within authority limits for medical, indemnity and expenses and recommending reserve changes to Team Leader throughout the life of the claim. Reviewing the claim status at regular intervals and making recommendations to Team Leader to discuss problems and remedial actions to resolve them. Preparing and submitting to Team Leader unusual or possible undesirable exposures when encountered. Working with attorneys to manage hearings and litigation. Controlling and directing vendors, nurse case managers, telephonic case managers and rehabilitation managers on medical management and return to work initiatives. Complying with customer service requests including Special Claims Handling procedures, file status notes and claim reviews. Filing workers' compensation forms and electronic data with states to ensure compliance with statutory regulations. Referring appropriate claims to subrogation and securing necessary information to ensure that recovery opportunities are maximized. Working 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. Requirements include: 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 and relationships with co-workers and clients. Willing to take ownership and tackle obstacles to meet client quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation. Superior verbal and written communication skills. 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 types 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. Why Should You Apply? Health Benefits Referral Program Excellent growth and advancement opportunities As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or expression, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.