TechLink Systems, Inc. · 1 week ago
Claims Examiner - Workers Compensation (CA Licensed) FB2026
Orange, CA, US
Full-time
Hybrid
Senior Level
5+ years expTechLink Systems, Inc. is a national provider of staffing services with a strong commitment to client relationships and operational excellence. They are seeking a Claims Examiner - Workers Compensation to analyze and process complex workers' compensation claims, manage claims through action plans, and ensure timely resolutions while maintaining professional relationships with clients.
Information TechnologySoftware EngineeringStaffing Agency
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 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
Performs other duties as assigned
Supports the organization's quality program(s)
Travels as required
Qualification
Required
Five (5) years of claims management experience or equivalent combination of education and experience required
Bachelor's degree from an accredited college or university preferred
Professional certification as applicable to line of business preferred
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
Company
TechLink Systems, Inc.
TechLink Systems is a national provider of staffing services with offices all over the USA as well as development and support centers globally.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
J
Jane Kim
CEO
Company data provided by crunchbase