Workers' Compensation Claims Examiner

Workers' Compensation Claims Examiner

BCforward is currently seeking a highly motivated Workers' Compensation Claims Examiner for an opportunity in CA (Remote)!

Position Title: Workers' Compensation Claims Examiner

Location: CA (Remote)

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 of contract

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

Pay Range: [$40.00] - [$45.00]

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:

• Workers Compensation
• California WC experience

Job Description:

Primary Purpose:

The Workers' Compensation Claims Examiner is responsible for managing and adjudicating complex or technically challenging workers' compensation claims, ensuring compliance with service expectations, industry standards, and client requirements. The role involves litigation management, settlement negotiation, and identifying opportunities for subrogation to optimize claim outcomes.

Essential Functions and Responsibilities:

Claims Analysis and Management:

• Investigate and process complex or technically challenging workers' compensation claims to determine exposure.
• Develop action plans to manage claims to an appropriate and timely resolution.
• Communicate claim activities and progress with claimants and clients.

Litigation and Settlement:

• Manage the litigation process, ensuring timely and cost-effective resolution.
• Negotiate settlements within designated authority limits.

Financial Management:

• Calculate and assign reserves, ensuring adequacy throughout the life of the claim.
• Approve and make timely claim payments and adjustments within designated authority levels.

Compliance and Reporting:

• Prepare and submit necessary state filings within statutory requirements.
• Report claims to excess carriers and respond professionally and promptly to their requests.

Cost Containment and Recovery:

• Use strategic vendor partnerships and cost-containment techniques to reduce claims costs.
• Manage recoveries, including subrogation, Second Injury Fund claims, and Social Security and Medicare offsets.

File Documentation and Referral:

• Ensure claim files are properly documented and coded accurately.
• Refer cases to supervisors or management as appropriate.

Additional Functions:

• Perform other assigned duties.
• Support organizational quality programs.
• Travel as required.

Qualifications:

• Education and Licensing:
• Bachelor's degree preferred.
• Professional certification in insurance or related field preferred.
• Experience:
• Minimum of 5 years in claims management, with at least 3 years of California workers' compensation claims experience.
• Skills and Knowledge:
• Expertise in workers' compensation principles, laws, cost containment, recoveries, and disability management.
• Proficiency with Microsoft Office and claim management systems.
• Strong analytical, interpretive, and organizational skills.
• Excellent negotiation and communication skills (oral and written).
• Ability to work in a collaborative team environment and meet service expectations.

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 233300 when responding to this ad.

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