- Location
- Brea, CA
- Type
- Full-time
- Department
- Human Resources
- Source
- PCRecruiter
Description
SIP certification required
3+years of relevant experience.
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
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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.
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Negotiates settlement of claims within designated authority.
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Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
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Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
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Prepares necessary state fillings within statutory limits.
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Manages the litigation process; ensures timely and cost effective claims resolution.
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Coordinates vendor referrals for additional investigation and/or litigation management.
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Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
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Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
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Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
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Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
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Ensures claim files are properly documented and claims coding is correct.
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Refers cases as appropriate to supervisor and management.
