Workers Compensation Claims Examiner III

Job Details
:
Level: Experienced |

Job Location:

Signal Hill Office
- Signal Hill, CA 90755 | Position Type:
Full Time | Education Level: High School Diploma or GED | Salary Range: $90,000.00 - $ |

Travel Percentage :
None |

Job Shift: Day | Job Category:
Admin
- Clerical

Position Summary
:
Under minimal supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. Requires extensive client interaction and consistent office presence.

• Effectively manage a caseload of 150 to 180 workers’ compensation files, including very complex claims (essential).
• Initiate and conduct investigations in a timely manner (essential).
• Determine compensability of claims and administer benefits per state law and company guidelines (essential).
• Manage medical treatment and billing; authorize as appropriate (essential).
• Refer cases to outside defense counsel and direct management as appropriate (essential).
• Communicate with claimants, providers, and vendors regarding claim issues (essential).
• Compute and set reserves within company guidelines (essential).
• Settle/finalize all claims and obtain necessary authority (essential).
• Maintain diary system for case review and file documentation to reflect status (essential).
• Communicate relevant information promptly to the client to resolve claims efficiently, including injury trends or safety concerns.
• Adhere to all company policies and procedures.
• Conduct file reviews independently.
• Perform other duties as assigned.

• Education:
  
  Bachelor’s degree in related field preferred; three (3) or more years related experience; or equivalent combination of education and experience.
• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication, including ability to convey technical details.
• Ability to interact with persons at all levels.
• Ability to independently and effectively manage complex claims.
• Proficiency in Word and Excel (preferred).
• Certifications/licenses as required by state regulation.

• Medical, Dental and Vision Insurance
• Life & Disability Insurance
• 401(K) Plan
• Paid holiday
• Paid time off
• Referral bonus

See separate attachment for a checklist of mental and physical requirements. Key functions include:

• Mental effort: reasoning, mathematical, and language development tasks ranging from simple to complex problem solving.
• Physical effort: light work up to 20 lbs, light manipulations, medium to heavy tasks, lifting, gripping, standing, walking, reaching, pushing, pulling, and other specified movements.
• Vision requirements: far, near, mid-range, depth perception, color and field of vision.