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: [ASAP]

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 of 3+ years of California workers' compensation
• Claims management experience

Job Description:

Job Summary:

To analyze complex and/or technically difficult workers' compensation claims to determine benefits due; to manage high-exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication in accordance with service expectations, industry best practices, and specific client service requirements; and to identify subrogation opportunities and negotiate settlements.

Essential Functions and Responsibilities

• Analyze and process complex or technically challenging workers' compensation claims by investigating and gathering information to assess claim exposure.
• Develop and execute comprehensive action plans to achieve timely and appropriate resolution of claims.
• Negotiate claim settlements within designated authority.
• Establish, review, and maintain adequate claim reserves throughout the life of the claim.
• Calculate and disburse benefits due; approve and process timely payments and adjustments.
• Ensure compliance with statutory filing requirements.
• Oversee the litigation process to support cost-effective and timely claim resolution.
• Coordinate referrals to vendors for further investigation or legal support as needed.
• Apply strategic cost-containment measures to reduce total claim cost.
• Manage claim recoveries such as subrogation, Second Injury Fund recoveries, and applicable Social Security/Medicare offsets.
• Report claims to excess carriers and respond promptly to carrier inquiries.
• Maintain open and professional communication with claimants and clients.
• Ensure claim files are thoroughly documented and coded correctly.
• Refer complex cases to supervisor or management when necessary.

Additional Responsibilities

• Perform other related duties as assigned.
• Support company quality assurance initiatives.
• Travel as needed.

Qualifications

Education & Licensing

• High School Diploma or GED required.
• Bachelor's degree from an accredited college or university preferred.
• Professional certifications relevant to claims management or workers' compensation preferred.

Experience

• Minimum of 3+ years of California workers' compensation claims experience required.
• At least 5 years of overall claims management experience or equivalent combination of education and experience preferred.

Skills & Knowledge

• In-depth knowledge of workers' compensation insurance principles, California WC laws, and industry practices.
• Strong understanding of medical management practices, cost containment, and recovery processes (e.g., subrogation, offsets).
• Excellent communication and presentation skills (written and verbal).
• Proficiency in Microsoft Office and general PC literacy.
• Strong analytical and organizational skills.
• Effective negotiation and interpersonal abilities.
• Ability to manage multiple priorities and meet deadlines in a team-oriented environment.

Work Environment

• Mental: Must be able to think clearly, exercise sound judgment, and handle multiple priorities with minimal supervision.
• Physical: Frequent computer use and occasional travel.
• Auditory/Visual: Requires normal hearing, vision, and verbal communication.
• Special Requirement: Credit security clearance confirmed via a background credit check.

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 237782 when responding to this ad.

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