Our Claims Examiners conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California. We function with a high degree of competency and sound judgment, coupled with consistent results!
Responsibilities for this opportunity include:
- Analyzing and processing workers’ compensation claims by investigating and gathering information to determine the exposure on the claim.
- Negotiating the settlement of claims up to designated authority level and making claims payments.
- Calculating and assigning timely and appropriate reserves to claims and continuing to manage reserve adequacy throughout the life of the claim.
- Calculating and paying benefits due; approving all claim payments; and settling claims within designated authority level.
- Developing and managing claims through well-developed action plans; continuing to work the action plan to bring the claim to an appropriate and timely resolution.
- Preparing necessary state filings within statutory limits.
- Actively managing the litigation process; ensuring timely and cost effective claims resolution.
- Coordinating vendor referrals for additional investigation and/or litigation management.
- Using appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
- Managing claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
- Reporting claims to the excess carrier, responds to requests of directions in a professional and timely manner.
- Frequently communicating with all appropriate parties involved with the claim.
- Referring cases as appropriate to management.
- Maintaining professional client relationships.
- Actively executing appropriate claims activities to ensure consistent delivery of quality claims service.