• To analyze mid to high level Workers Compensation Lost-Time claims on behalf of our valued clients to determine benefits due. • Ensuring ongoing adjudication of claims within service expectations. • Investigating and gathering information to determine the exposure on the claim. • Negotiating settlement of claims within designated authority. • Communicating claim activity and processing with the claimant and the client. • Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

• To analyze mid- and higher-level workers compensation claims to determine benefits due; • to ensure ongoing adjudication of claims within company standards and industry best practices; • and to identify subrogation of claims and negotiate settlements. • Manage workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency. • Develop and manage workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments. • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. • Manages subrogation of claims and negotiates settlements. • Communicates claim action with claimant and client. • Ensures claim files are properly documented and claims coding is correct. • May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review. • Maintains professional client relationships.

• Ensure timely processing of pending medical claims • Verify and update information on the submitted claims • Review work processes to determine reimbursement eligibility • Ensure payments and/or denials are made in accordance with company protocols and procedures • Process first time claims • Apply policy and provider contract provisions to determine if claim is payable • Research and determine status of medical related claims • Maintain records, files, and documentation as appropriate • Meet and maintain department production and quality standards • Successfully complete additional progressive claims training programs as required • Performs other duties as assigned • Complies with all policies and standards

Location: USA- Job Description: Our client, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation for their Remote in CA location. Responsibilities: - 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. - 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. - 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). Requirements: - Minimum 3years of relevant CA WC claims experience is mandatory - California WC Claims handling experience - Must have OSIP certificate - Education & Licensing: Bachelor'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. Why Should You Apply? - Health Benefits - Referral Program - Excellent growth and advancement opportunities