Claim Examiner – WorkersÂ’ Compensation (remote)
Location: Must reside in the state of California…
Pay: Depends on experience
Duties of the Claim Examiner – WorkersÂ’ Compensation:
• Receive claim assignments and confirm policy coverages.
• Interpret and make decisions using independent judgment on moderate difficulty claims and policy coverages.
• Investigate, evaluate, negotiate, and adjudicate first and third-party claims to determine validity and verify the extent of damage. This involves telephone contact with clients, claimants, witnesses, or other relevant parties.
• Analyze claims activity and prepare reports for clients, carriers, and management.
• Establish reserves, authorize payments within the scope of authority, and settle claims in a cost-effective manner, ensuring timely disbursements.
• Make prompt and equitable settlement decisions, issuing company drafts for authorized claims.
• Develop subrogation and third-party recovery potential, following reclaim procedures.
• Participate in claim reviews.
Job Requirements
Skills Required for the Claim Examiner – WorkersÂ’ Compensation:
• Ability to work independently while assimilating various technical subjects.
• Strong verbal and written communication skills.
• Demonstrated ability to gather and analyze information, determine a course of action, and implement the selected approach.
• Proficiency in problem-solving and identifying solutions.
• Effective interpersonal skills for dealing with external sources and colleagues at all levels.
Education:
• Bachelor’s degree or equivalent experience required.
• 1-3 years of comprehensive claims investigations/settling experience in Workers’ Compensation or a similar organization
