Claims Examiner - Workers Compensation

BC Forward is looking for Workers' Compensation Claims Specialist (Remote/Onsite)

Job Title: Workers' Compensation Claims Specialist (Remote/Onsite)
Location: Remote or Onsite (CA 95678)
Experience Required: 5+ years of relevant experience with Workers' Compensation (WC) claims
Education Required: High School Diploma/GED (Bachelor's preferred)
Certification: SIP Certification Preferred

Primary Purpose:

To analyze, manage, and resolve complex and/or high-exposure Workers' Compensation claims. This includes investigating claims, determining appropriate benefits, navigating litigation and rehabilitation, identifying subrogation opportunities, and negotiating settlements in line with best practices and client expectations.

Key Responsibilities:

• Analyze and process complex WC claims by investigating and evaluating exposure.
• Develop and execute strategic action plans to ensure timely claim resolution.
• Negotiate settlements within designated authority levels.
• Establish and adjust reserves based on claim progression.
• Calculate and authorize benefit payments in a timely manner.
• Complete and file necessary state documentation within required timelines.
• Manage litigation process, coordinating with legal and third-party vendors as needed.
• Implement cost containment strategies through effective vendor partnerships.
• Handle recovery processes including subrogation, Second Injury Fund, and Medicare/SS offsets.
• Report claims to excess carriers and respond to inquiries as needed.
• Maintain professional and timely communication with claimants and clients.
• Ensure claims files are thoroughly documented and coded accurately.
• Escalate complex or sensitive cases to supervisor/management when necessary.

Additional Responsibilities:

• Perform other duties as assigned.
• Support company quality initiatives.
• Travel as needed (minimal).

Qualifications:

Education & Licensing:

• High School Diploma/GED required.
• Bachelor's degree from an accredited institution preferred.
• SIP certification strongly preferred.

Experience:

• Minimum 5 years of Workers' Compensation claims management or a related role.

Skills & Knowledge:

• In-depth knowledge of Workers' Compensation laws, medical management, and claim/litigation processes.
• Strong analytical, problem-solving, and decision-making abilities.
• Excellent negotiation, interpersonal, and communication (written & verbal) skills.
• Proficiency in Microsoft Office Suite and claims management systems.
• Ability to work independently and within a collaborative team environment.
• Proven ability to meet deadlines and exceed service expectations.

Work Environment Requirements:

• Mental: Must be able to manage multiple priorities, handle stress, analyze complex information, and make sound decisions.
• Physical: Computer use, occasional travel.
• Auditory/Visual: Must be able to communicate clearly and interpret information accurately.

Additional Notes:

• Credit and background check required as part of the employment process.
• Position is open to both remote and onsite candidates.
• The role is subject to modifications by management as needed.

About BCforward

Founded in 1998, BCforward is a Black-owned global leader in workforce management and digital product delivery solutions, headquartered in Indianapolis, IN. With a worldwide team of over 6,000 consultants, BCforward is dedicated to empowering human potential through its core values: People-Centricity, Excellence, and Diversity.

As an industry pioneer, BCforward provides a best-in-class workplace, fostering a culture of accountability, innovation, and optimism. Committed to equal opportunity employment, the company champions diversity and inclusion, striving to create a positive impact for its clients, employees, and communities.

Interested candidates please send resume in Word format Please reference job code 240584 when responding to this ad.