Sunrise Systems, Inc. ยท 1 day ago
Workers' Compensation Specialist
Los Angeles, CA
Contract
Onsite
Senior Level
$44/hr - $48/hrSunrise Systems, Inc. is currently seeking a Workers' Compensation Lost Time Senior Claim Examiner for their West Coast/Pacific region. The successful applicant will handle claims from California, ensuring strong customer relations and managing all aspects of workers' compensation lost time claims from set-up to case closure.
Information Technology & Services
Hiring Manager
Vijay Gowda
Responsibilities
Handles all aspects of workers' compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process
Reviews claim and policy information to provide background for investigation
Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers
Evaluates the facts gathered through the investigation to determine compensability of the claim
Informs insureds, claimants, and attorneys of claim denials when applicable
Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc
Timely administration of statutory medical and indemnity benefits throughout the life of the claim
Sets reserves within authority limits for medical, indemnity and expenses and recommends reserve changes to Team Leader throughout the life of the claim
Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them
Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered
Works with attorneys to manage hearings and litigation
Controls and directs vendors, nurse case managers, telephonic cases managers and rehabilitation managers on medical management and return to work initiatives
Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews
Files workers' compensation forms and electronic data with states to ensure compliance with statutory regulations
Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized
Works with in-house Technical Assistants, Special Investigators, Nurse Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service
Qualification
Required
Lost Time Claim Examiner position with prior experience in workers' compensation as a lost time examiner, or similar examiner experience in short-term / long-term disability, auto personal injury protection / medical injury, or general liability claims
Requires basic knowledge of workers' compensation statutes, regulations, and compliance
Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues
Exceptional customer service and focus
Ability to openly collaborate with leadership and peers to accomplish goals
Demonstrates a commitment to a career in claims
Exceptional time management and multi-tasking capabilities with consistent follow through to meet deadlines
Use analytical skills to find mutually beneficial solutions to claim and customer issues
Ability to prepare and make exceptional presentations to internal and external customers
Conscientious about the quality and professionalism of work product and relationships with co-workers and clients
Willing to take ownership and tackle obstacles to meet Chubb's quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation
Superior verbal and written communication skills
Experience working in a customer focused, fast-paced, fluid environment
Experience utilizing strong communication and telephonic skills
Prior experience requiring a high level of organization, follow-up, and accountability
Prior workers' compensation claim handling experience or other similar type of claim handling experience is required (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, or general liability)
Knowledge of medical terminology is required
Knowledge of bill processing is required
Certification to handle CA Workers Compensation claims is required
Proficiency with Microsoft Office Products
If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure
Preferred
Prior insurance, legal or corporate business experience is a plus but not required
AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required
Experience handling claims in the states of CO, UT, NV and AZ preferred
Benefits
ACA-compliant medical coverage
Dental insurance
Vision insurance
Sick time benefits as required per State regulations
Company
Sunrise Systems, Inc.
Sunrise Systems was founded in 1990 with a clear vision to deliver world-class staffing service solutions in all labor categories, including IT consulting and solutions; all with the commitment to provide service that exceeds expectations and become the most trusted name in the industry.
Founded in 1990
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Ruchi Hajra
Senior Account Manager/Client Servicing/Talent Acquisition Partner
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