Claims Examiner - Workers Compensation

Claims Examiner - Workers Compensation

BCForward is looking for Workers' Compensation Claims Manager- Remote

Position Title: Workers' Compensation Claims Manager

Location: Remote or Onsite (8855 Haven Ave., Rancho Cucamonga, CA 91730)

Location Requirement: Candidate must be based in California

Anticipated Start Date: ASAP

Expected Duration: 03+ months

Job Type: FULL TIME (>%3D40 HRS WEEKLY, [CONTRACT], [REMOTE]

Pay Rate: $50/hr on W2

Shift: 8:00 AM - 5:00 PM, Monday to Friday

Position Summary:

The Workers' Compensation Claims Manager is responsible for analyzing and processing complex workers' compensation claims, including those with high exposure, litigation, and rehabilitation components. This role involves ensuring the timely and cost-effective resolution of claims while adhering to service expectations, industry best practices, and specific client requirements. The manager will negotiate settlements, handle subrogation, and coordinate with vendors for further investigation or litigation management. The ideal candidate will possess a deep understanding of workers' compensation laws, claims management processes, and cost containment strategies.

Primary Responsibilities:

• Claims Analysis & Management:
  Analyze complex workers' compensation claims, gathering necessary information to assess claim exposure. Develop and execute action plans for the timely and appropriate resolution of claims.
• Settlement Negotiation:
  Negotiate the settlement of claims within the designated authority level to ensure fair and timely resolution for all parties involved.
• Claims Reserves & Payments:
  Calculate and assign appropriate reserves for claims, ensuring their adequacy throughout the claims process. Approve and make timely payments and adjustments to claims.
• State Filings & Statutory Compliance:
  Prepare and submit necessary state filings within statutory limits to ensure compliance with state regulations.
• Litigation Management:
  Manage the litigation process, ensuring that claims are resolved in a cost-effective manner while minimizing legal expenses. Coordinate with vendors for additional investigation or litigation management.
• Cost Containment & Vendor Management:
  Utilize cost containment techniques, including strategic partnerships with vendors, to reduce the overall cost of claims. Manage claim recoveries, including subrogation, Second Injury Fund recoveries, and Social Security and Medicare offsets.
• Reporting & Communication:
  Report claims to the excess carrier and respond to their requests for directions in a professional and timely manner. Maintain ongoing communication with clients and claimants, providing status updates and ensuring client satisfaction.
• Documentation & Claims Coding:
  Ensure all claim files are properly documented and that claims coding is accurate. Review claims regularly to ensure compliance with company procedures and industry standards.
• Collaboration & Supervision:
  Work closely with the supervisor and management to refer cases as needed. Participate in team discussions to continuously improve claims management practices.

Additional Responsibilities:

• Perform other duties as assigned, supporting the organization's overall quality programs.
• Travel as required for claims investigations, client meetings, or other related purposes.

Qualifications:

Education & Licensing:

• Bachelor's degree in a relevant field (preferred).
• Professional certification in claims management or related discipline (preferred).
• Self-insured certification preferred.

Experience:

• At least 4 years of experience in workers' compensation claims management or a combination of education and relevant experience.

Skills & Knowledge:

• Expertise in Workers' Compensation Claims Management:
  Deep understanding of insurance principles, workers' compensation laws, cost containment strategies, and recovery offsets (e.g., Social Security and Medicare applications).
• Excellent Communication Skills:
  Strong oral and written communication skills, including the ability to effectively present and communicate complex information to clients, claimants, and vendors.
• Negotiation & Analytical Skills:
  Exceptional negotiation skills with the ability to make informed decisions based on thorough analysis and interpretation of claims data.
• Technically Proficient:
  Proficient with Microsoft Office Suite (Excel, Word, etc.) and claims management software (EMR systems, Athenahealth).
• Organizational Skills:
  Strong organizational skills and the ability to manage multiple claims concurrently while maintaining high-quality service.

Team Collaboration:
Ability to work effectively within a team environment, sharing knowledge and supporting

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 230905 when responding to this ad.

---