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: CA (Remote)

Anticipated Start Date: [1/27/2025]

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 of contract

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

Pay Range: [$45.00] - [$50.00]

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.).

Requirements:

• Claims
• Workers Compensation

Job Description:

Primary Purpose:
To analyze complex or technically difficult workers' compensation claims, determining benefits due while managing high-exposure claims involving litigation and rehabilitation. Ensure ongoing adjudication of claims aligns with service expectations, industry best practices, and specific client requirements. Identify subrogation opportunities and negotiate settlements.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Analyze and manage complex or technically challenging workers' compensation claims, developing actionable plans for timely resolution.
• Negotiate claim settlements within designated authority.
• Calculate and assign reserves promptly, ensuring reserve adequacy throughout the claim lifecycle.
• Process and approve timely claim payments and adjustments within authority limits.
• Prepare and submit state filings within statutory guidelines.
• Oversee litigation processes to ensure timely and cost-effective claim resolution.
• Coordinate vendor referrals for further investigation or litigation management as needed.
• Employ cost containment strategies, including strategic vendor partnerships, to minimize overall claim costs.
• Manage recoveries such as subrogation, Second Injury Fund excess recoveries, and Social Security/Medicare offsets.
• Communicate effectively with claimants and clients, maintaining professional relationships.
• Ensure accurate documentation and coding of claim files.
• Refer complex cases to supervisors or management as appropriate.

Qualifications:

Education & Licensing:

• Bachelor's degree from an accredited institution preferred.
• Professional certification in relevant areas preferred (e.g., CA SIP).

Experience:

• Minimum 3 years of California workers' compensation claims management experience required.
• CA Self-Insured Plan (SIP) certification preferred but not mandatory.

Skills & Knowledge:

• Expertise in insurance principles, laws, and best practices for workers' compensation.
• Proficiency in managing recoveries, offsets, and deductions.
• Strong understanding of medical management practices and Social Security/Medicare applications.
• Excellent oral and written communication skills, including presentation capabilities.
• Proficiency in Microsoft Office and other relevant PC applications.
• Strong analytical, organizational, negotiation, and interpersonal skills.
• Ability to meet or exceed service expectations in a team environment.

WORK ENVIRONMENT:

Mental:

• Clear thinking, strong judgment, and effective problem-solving skills.
• Ability to manage multiple priorities, meet deadlines, and handle work-related stress.

Physical:

• Frequent computer use, occasional travel.

Auditory/Visual:

• Clear vision, hearing, and effective communication abilities.

ADDITIONAL REQUIREMENTS:

• Background credit check required for security clearance.

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 234189 when responding to this ad.

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