Claims Examiner - Workers Compensation

Claims Examiner - Workers Compensation

BCforward is currently seeking a highly motivated Workers' Compensation Claims Examiner for an opportunity in Orange, CA 92868!

Position Title: Workers' Compensation Claims Examiner

Location: Orange, CA 92868!

Anticipated Start Date: 10/7/2024

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: 6+ Months

Job Type: [FULL TIME (>%3D30 HRS WEEKLY], [CONTRACT], [REMOTE]

Pay Range: [$42.00] - [$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.).

Job Description: Workers' Compensation Claims Examiner

**PRIMARY PURPOSE:**
To analyze complex or technically challenging workers' compensation claims, determine benefits due, and manage high-exposure claims involving litigation and rehabilitation. This role ensures ongoing adjudication of claims meets service expectations, industry best practices, and specific client requirements while identifying subrogation opportunities and negotiating settlements.

**ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:**
- Analyze and process complex workers' compensation claims by investigating and gathering information to assess claim exposure.
- Develop and implement action plans for timely resolution of claims.
- Negotiate settlements within designated authority limits.
- Calculate and assign appropriate reserves; monitor reserve adequacy throughout the claim lifecycle.
- Process and pay benefits due; ensure timely claim payments and adjustments.
- Prepare necessary state filings within statutory limits.
- Manage the litigation process to ensure timely and cost-effective claims resolution.
- Coordinate vendor referrals for further investigation or litigation management.
- Utilize cost containment techniques, including strategic vendor partnerships, to minimize overall claims costs.
- Manage claim recoveries, including subrogation and offsets from Social Security and Medicare.
- Report claims to excess carriers; respond to requests in a professional and timely manner.
- Maintain communication regarding claim activity with claimants and clients; foster professional client relationships.
- Ensure proper documentation and coding of claim files.
- Refer cases to supervisors and management as appropriate.

**ADDITIONAL FUNCTIONS AND RESPONSIBILITIES:**
- Perform other duties as assigned.
- Support the organization's quality programs.
- Travel as required.

**QUALIFICATIONS:**

**Education & Licensing:**
- Bachelor's degree from an accredited college or university preferred.
- Professional certification relevant to the line of business preferred (e.g., SIP Certification).

**Experience:**
- Minimum of five (5) years of claims management experience or equivalent combination of education and experience required, specifically in California workers' compensation.

**Skills & Knowledge:**
- Subject matter expertise in relevant insurance principles and laws, recovery offsets, claim duration, and cost containment.
- Excellent oral and written communication skills, including presentation abilities.
- Proficient in Microsoft Office and other relevant software.
- Strong analytical and interpretive skills.
- Excellent organizational and interpersonal skills.
- Exceptional negotiation skills and ability to work collaboratively in a team environment.
- Ability to meet or exceed 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.

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 229599 when responding to this ad.

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