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Claims Examiner-Workers Compensation

  • Location: Long Beach
  • Job Type:Contract

Posted 18 days ago

  • Expiry Date: 09 December 2021

​​Job Description:

  • 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 the overall cost of claims for our clients. 

  • Manages 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 & LicensingBachelor'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  

About ASK:ASK Consulting is an award-winning technology and professional services recruiting firm servicing Fortune 500 organizations nationally. With 5 nationwide offices, two global delivery centers, and employees in 42 states-ASK Consulting connects people with amazing opportunities

ASK Consulting is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all associates.