Claims Examiner - Workers Compensation

BCForward is looking for Workers' Compensation Claims Examiner- Remote- CA

Position Title: Workers' Compensation Claims Examiner

Locations: Pasadena, CA 91107 (Remote- Out-of-state adjusters allowed with California WC experience)

Anticipated Start Date: Jan 2025
Duration: 02+ Months

Pay Rate: $43.00/hr on W2

Job Summary: We are seeking an experienced Workers' Compensation Claims Examiner with a minimum of 3 years of experience handling California Workers' Compensation claims. The role involves analyzing complex claims, managing litigation, ensuring timely claim resolution, and negotiating settlements. The ideal candidate will possess in-depth knowledge of California Workers' Compensation laws, excellent negotiation skills, and a strong understanding of cost containment strategies.

Primary Purpose: To analyze and manage complex or technically difficult Workers' Compensation claims, ensuring appropriate benefits are paid, settlements are negotiated, and claims are resolved within service expectations, industry best practices, and client requirements.

Essential Functions and Responsibilities:

• Analyze and process complex Workers' Compensation claims, investigating and gathering necessary information to determine exposure and develop action plans for timely resolution.
• Negotiate settlements within designated authority and calculate timely and appropriate reserves for claims.
• Ensure accurate and timely payment of benefits, including claim adjustments and settlements, within designated authority.
• Prepare necessary state filings in compliance with statutory limits and deadlines.
• Manage the litigation process, ensuring timely and cost-effective resolution of claims.
• Coordinate referrals to vendors for additional investigations or litigation management.
• Implement cost containment techniques, including partnerships with strategic vendors to reduce overall claim costs.
• Manage recoveries such as subrogation, Second Injury Fund, and Social Security and Medicare offsets.
• Report claims to excess carriers and respond to directions professionally and in a timely manner.
• Maintain communication with claimants and clients, ensuring claims activity is clearly communicated and professional relationships are upheld.
• Ensure accurate documentation and coding of claim files.
• Refer complex cases to supervisors and management as appropriate.

Additional Functions and Responsibilities:

• Perform other duties as assigned.
• Support the organization's quality programs and initiatives.
• Travel as required for case management or client needs.

Qualifications:

Education & Licensing:

• Bachelor's degree preferred, or equivalent work experience.
• Professional certification applicable to Workers' Compensation claims preferred.
• Active Workers' Compensation adjuster license in California (or equivalent state if out-of-state).

Experience:

• Minimum of 3 years of experience handling California Workers' Compensation claims, with expertise in managing complex, high exposure claims.
• Experience with litigation management and settlement negotiation.

Skills & Knowledge:

• Expertise in California Workers' Compensation laws and regulations.
• Strong understanding of cost containment practices, including medical management and Social Security/Medicare offsets.
• Excellent written and verbal communication skills, including the ability to present complex information clearly.
• Proficient in Microsoft Office and claims management software.
• Strong analytical, interpretive, and organizational skills.
• Excellent negotiation and interpersonal skills.
• Ability to work effectively in a team environment and meet service expectations.

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 233380 when responding to this ad.