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Job Requirements of Claims Examiner - Workers Compensation:
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Employment Type:
Contractor
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Location:
Signal Hill, CA (Onsite)
Do you meet the requirements for this job?
Claims Examiner - Workers Compensation
Position Title: Claims Examiner - Workers Compensation Locations: Long Beach, CA 90806
Anticipated Start Date: ASAP
Expected Duration: 3 Months
Job Type: Contract with possible extension
Pay Rate $46.97/hr. on W2
Need: Minimum 2 years of Workers' Compensation Claims Handling experience required; WCCA and SIP License preferred.
Interview Process: 1- Phone Screen , 2 - Video Interview.
Job Description:
Hiring Manager's Note:
- Workers' Compensation Claims Handling Experience required
- Preferred Certifications/Licenses: WCCA, SIP License
- Minimum Experience: 2 years and above
Position Summary
The Workers' Compensation Claims Specialist will analyze complex or technically challenging workers' compensation claims to determine appropriate benefits. This role involves managing high-exposure claims, including those involving litigation and rehabilitation efforts. The ideal candidate ensures timely and compliant claim adjudication in accordance with industry best practices, client-specific service requirements, and regulatory standards. Responsibilities also include identifying subrogation opportunities and negotiating settlements effectively.
Key Responsibilities
- Claims Management: Analyze and process complex workers' compensation claims by conducting investigations and gathering relevant data to assess exposure; develop and execute action plans leading to timely resolution.
- Settlement Negotiations: Negotiate settlements within assigned authority levels.
- Reserve Management: Accurately calculate and assign initial reserves; monitor and adjust reserve amounts throughout the lifecycle of each claim.
- Benefits Administration: Approve and process benefit payments in a timely manner; manage adjustments and settlements within designated authority.
- Compliance & Documentation: Prepare and submit state filings within statutory deadlines; ensure accurate documentation and coding in claim files.
- Litigation Oversight: Manage the litigation process to achieve cost-effective and timely resolutions.
- Vendor Coordination: Coordinate referrals to external vendors for investigative or litigation support; implement cost containment strategies through strategic vendor partnerships.
- Recovery Management: Pursue claim recoveries through subrogation, Second Injury Fund, Social Security, and Medicare offsets.
- Carrier Communication: Report claims to excess carriers and respond promptly and professionally to requests for direction.
- Stakeholder Communication: Maintain regular communication with claimants and clients; build and sustain strong client relationships.
- Escalation: Refer complex cases to supervisors or management as needed.
Additional Responsibilities
- Perform other duties as assigned.
- Support company quality assurance programs.
- Travel as required.
Qualifications
Education & Certifications
- Bachelor's degree from an accredited college or university is preferred.
- Professional certification related to insurance or claims handling (e.g., WCCA) is preferred.
- SIP License is preferred.
- Minimum of 5 years of experience in claims management, or equivalent combination of education and experience.
- Expert knowledge of workers' compensation laws, regulations, and principles.
- Understanding of disability duration, recovery offsets, and deductions.
- Familiarity with cost containment strategies, medical management practices, and Social Security/Medicare application procedures.
- Strong analytical, interpretive, and problem-solving abilities.
- Excellent written and verbal communication and presentation skills.
- Proficient in Microsoft Office Suite and PC-based systems.
- Strong organizational and interpersonal skills.
- Proven negotiation and teamwork capabilities.
- Ability to manage multiple priorities and meet service expectations.
Work Environment
- Mental Demands: Requires clear thinking, sound judgment, problem-solving, discretion, and ability to handle work-related stress and multiple tasks simultaneously.
- Physical Demands: Includes computer keyboarding and occasional travel as needed.
- Sensory Requirements: Requires normal hearing, vision, and speaking ability.
Additional Requirements
- A credit security clearance , confirmed via background credit check, is required for this position.
Equal Opportunity Statement
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
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 238604 when responding to this ad.