Claims Examiner - Workers Compensation

Claims Examiner - Workers Compensation

BCforward is currently seeking a highly motivated Claims Examiner - Workers Compensation Job for an opportunity in hybrid Concord CA 94520

Position: Claims Examiner - Workers Compensation

Worksite: hybrid /Concord CA 94520

Duration: 2+ Months

Pay Rate: $46.42/hour on W2

Job Summary

We are seeking an experienced Workers' Compensation Claims Examiner to join our team. This role requires an individual with strong analytical skills, excellent customer service, and the ability to handle complex claims with a high level of expertise. The ideal candidate will have at least three (3) years of experience and hold a Self-Insurance Plan (SIP) Certificate (preferred). Candidates must be based in California, with a preference for those who can work on-site in Concord, CA.

Primary Responsibilities

• Analyze and process complex workers' compensation claims, ensuring compliance with industry best practices and client service expectations.
• Conduct claim investigations, gather necessary information, and develop action plans to facilitate timely resolution.
• Negotiate settlements within designated authority and ensure appropriate benefit calculations.
• Assign, manage, and maintain reserve adequacy throughout the claim lifecycle.
• Approve and process payments efficiently while making necessary adjustments.
• Prepare state filings within statutory limits and ensure regulatory compliance.
• Manage litigation, collaborate with attorneys, and implement cost-effective resolution strategies.
• Coordinate vendor referrals for additional investigation, litigation management, and cost containment.
• Monitor subrogation, excess recoveries, and offsets such as Social Security and Medicare.
• Report claims to the excess carrier and handle carrier communication professionally.
• Maintain professional client relationships, ensuring clear and timely communication regarding claim activities.
• Keep claim files properly documented and ensure coding accuracy.
• Escalate cases as necessary to supervisors or senior management.
• Support organizational quality programs and ensure service excellence.
• Perform additional duties as assigned and travel as required.

Qualifications & Requirements

Education & Certification

• High School Diploma/GED required; bachelor's degree preferred.
• SIP Certificate preferred.

Experience

• Minimum of three (3) years of claims management experience.
• Experience handling high exposure claims involving litigation and rehabilitation is a plus.

Skills & Knowledge

• In-depth knowledge of workers' compensation laws, principles, and best practices.
• Strong understanding of cost containment strategies, medical management practices, and Medicare procedures.
• Excellent communication skills (oral and written), including the ability to interact with clients and claimants effectively.
• Proficiency in Microsoft Office Suite and other claims management software.
• Strong analytical and problem-solving skills with the ability to assess claim exposures accurately.
• Strong organizational and time-management skills to handle a high-volume caseload efficiently.
• Ability to negotiate effectively and reach favorable claim settlements.
• Ability to work both independently and in a team-oriented environment.
• Must meet or exceed service expectations and uphold company standards.

Work Environment

• Hybrid Preferred: On-site work at the Concord, CA office is preferred, but remote candidates residing in California will also be considered.
• Mental Demands: Requires strong analytical thinking, problem-solving, multitasking, and the ability to work under pressure.
• Physical Demands: Requires frequent computer usage. Occasional travel may be required.
• Auditory/Visual Demands: Requires strong hearing, vision, and verbal communication skills.
• Security Clearance: Background credit check required.

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 235196 when responding to this ad.

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