Claims Examiner - Workers Compensation

Claims Examiner - Workers Compensation

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

Position Title: [Claims Examiner - Workers Compensation]

Location: [Remote-CA]

Anticipated Start Date: [4/21/2025]

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Expected Duration: [3 Months Contract]

Job Type: [FULL TIME (>%3D30 HRS WEEKLY)/PART TIME (<30 HRS WEEKLY)], [CONTRACT], [REMOTE]

Pay Range: [$45] - [$50]

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.).

Requirements:

• Minimum 3 years of relevant California Workers' Compensation (CA WC) experience required
• SIP (Self-Insurance Plans) certification is mandatory.

Job Description:

Position Overview:

The Senior Workers' Compensation Claims Examiner is responsible for analyzing and managing complex or technically challenging workers' compensation claims. This role requires a strong understanding of California WC regulations and practices, with a focus on delivering high-quality service, ensuring proper adjudication, and negotiating fair and timely settlements.

Essential Functions and Responsibilities:

• Analyze and manage complex or technically difficult CA WC claims from start to resolution
• Develop well-structured action plans and manage claims to timely and appropriate conclusions
• Negotiate settlements within designated authority levels
• Accurately calculate and set reserves; monitor reserve adequacy throughout claim lifecycle
• Approve and process timely benefit payments and adjustments
• Prepare and submit necessary state filings within statutory deadlines
• Manage litigation process and collaborate with legal partners for cost-effective resolution
• Coordinate vendor referrals for further investigation or litigation support
• Utilize cost containment strategies, including effective vendor partnerships
• Handle claim recoveries (e.g., subrogation, Second Injury Fund, SSDI/Medicare offsets)
• Report claims to excess carriers and respond to direction requests promptly
• Maintain open and professional communication with claimants, clients, and internal stakeholders
• Ensure thorough documentation and correct coding of all claim files
• Escalate cases to supervisors or management as needed

Additional Responsibilities:

• Support company quality initiatives
• Perform additional duties as assigned
• Travel occasionally as required

Qualifications:

Education and Licensing:

• Bachelor's degree preferred
• SIP certification required
• Additional certifications relevant to Workers' Compensation are a plus

Experience:

• Minimum 3 years of recent, relevant experience in California Workers' Compensation claims
• 5+ years of overall claims management experience preferred
• Experience with public entities and/or County of Los Angeles claims is highly desirable

Skills and Knowledge:

• Expert understanding of CA Workers' Compensation laws, procedures, and best practices
• Knowledge of recoveries, offsets, disability durations, and cost containment strategies
• Strong negotiation, communication, and analytical skills
• Proficient in Microsoft Office Suite and claims management software
• Ability to work independently and collaboratively in a remote setting
• Proven track record of meeting or exceeding service expectations

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.

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About BCforward:

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 237279 when responding to this ad.

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