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Company

Keenan · 3 days ago

Senior Claims Examiner - WC

Riverside, CA

Full-time

Remote

Mid, Senior Level

$75K/yr - $100K/yr

5+ years exp

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Insurance

Growth Opportunities

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Responsibilities

Maintain current diary.

Identify, prevent and mitigate potential penalties.

Update claim notes in computer.

Provide timely reporting of excess files to the Reinsurance Manager.

Report SIU/Fraud.

Identify and pursue subrogation.

Complete Rehab forms/benefit notices/SJDB/RTW form.

Refer all PRIME deletions only to office designee.

Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim.

Prepare for and attend file reviews.

Accept or deny delayed claims within 90 days.

Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date.

Complete Stipulation and/or Compromise and Release paperwork.

Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually.

Prepare legal referrals, provide direction to and monitor defense attorney.

Return all phone calls within 24 hours.

Complete instruction sheets for Assistant/Technician/Claims entry clerk.

Review mail daily.

Correct error report daily.

Maintain client/claimant satisfaction.

Update Unit Stat forms.

Oversee new set-ups, reserves and instruction sheets.

Prepare cover letters to AME/defense QME, AOE/COE evaluations.

Negotiate outstanding liens.

Make 3-point contact.

File Answer/Application.

Interaction with nurse on case management.

Other duties assigned.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claims ExaminerSelf-Insurance CertificatePublic entity claimsMicrosoft OutlookMicrosoft ExcelMicrosoft PowerPointMicrosoft Word

Required

Minimum of five (5) years of California Workers' Compensation Claims Examiner experience and a Self-Insurance Certificate, or the ability to pass Self-Insurance Test within one (1) year of hire.

Effective in verbal and written communication.

Proficient in Microsoft Outlook, Excel, PowerPoint and Word.

Adept at accessing business data from the Internet when required.

Preferred

WCCP preferred.

Two (2) years of experience in handling public entity claims is preferred.

Benefits

Generous 30+ Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days.

Health benefit options with you in mind; 5 affordable medical plan options with rates based on your salary, company paid HSA contribution with eligible HSA plan selection, 2 dental plan options offering orthodontia coverage and 3 cleanings per year, and 2 vision plan options.

Company match 401(k) plan – 50% up to 6%!

Support of your fitness wellness goals! We offer up to 75% off at over 11,000 gyms and fitness centers.

Opportunity to prioritize your mental health with 24/7 access to licensed therapists.

Pet benefits & discounts.

Access to our Employee-led Resource Groups (ERGs) that lend a voice to the variety of demographics represented throughout our company.