Claims Representative - Workers Compensation

BCforward is currently seeking a highly motivated Claims Representative - Workers Compensation for an opportunity in CA, Remote!

Position Title: Claims Representative - Workers Compensation

Location: CA, Remote

Anticipated Start Date: 11/11/2024

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: 2+ Months of contract with possible extension

Job Type: [FULL TIME (>%3D30 HRS WEEKLY)], [CONTRACT], [REMOTE]

Pay Range: $40 - $45/hr.

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:

• Self-Insurance Plans Certificate.
• Claims Examiner - Worker's Compensation.

Job Description:

Job Duties:

Looking for an experienced examiner to handle a heavy complex claims desk with mainly litigated claims. I want someone who can move fast and is good at closing claims. This is one of our more complex desks on the team working for a prestigious client, so I need someone who is reliable and has good references.

Self-Insurance Plans Certificate.

Primary Purpose: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

Essential Functions and Responsibilities:

Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

Negotiates settlement of claims within designated authority.

Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

Prepares necessary state fillings within statutory limits.

Manages the litigation process; ensures timely and cost-effective claims resolution.

Coordinates vendor referrals for additional investigation and/or litigation management.

Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.

Manage's claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

Ensures claim files are properly documented, and claims coding is correct.

Refers cases as appropriate to supervisor and management.

Additional Functions and Responsibilities:

Performs other duties as assigned.

Supports the organization's quality program(s).

Travels as required.

Qualification:

Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience: Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge:

Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

Excellent oral and written communication, including presentation skills.

PC literate, including Microsoft Office products.

Analytical and interpretive skills.

Strong organizational skills.

Good interpersonal skills.

Excellent negotiation skills.

Ability to work in a team environment.

Ability to meet or exceed Service Expectations.

Work environment: When applicable and appropriate, consideration will be given to reasonable accommodation.

simultaneously, and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.

Physical: Computer keyboarding, travel as required.

Auditory/Visual: Hearing, vision and talking.

Note: Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Qualifications:

Manager's note: Self Insurance Plans Certificate.

Work location: Possibly remote but only in CA. Ideal is if we had someone close to the office that could come one day a week with the rest of the team to help answer questions and training.

Years of experience required: at least 5 years of experience.

Any specific skill/ certifications/ license/ experience: SIP license.

Number of case load: 140. They are not going to make a lot of new losses on this desk unless we get swamped as this is our busy period. The goal of the desk is to settle as many of the older claims as possible. JURIS, if possible, located in CA, SIP license.

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.

Keywords:

[Self-Insurance Plans Certificate, and Claims Examiner - Worker's Compensation.]

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 230904 when responding to this ad.