Claims Examiner - Workers Compensation at BC Forward in Orange, California

Job Description:

Claims Examiner - Workers Compensation



BC Forward is looking for Claims Examiner - Workers Compensation in Orange, CA 92868 (Remote)

Position Title: Claims Examiner - Workers Compensation




Locations: Orange, CA 92868 (Remote)




Anticipated Start Date: 8/5/2024




Pay Rate: $45/hr on W2




Workers' Compensation Claims Specialist




Location: Remote, California (Candidate must reside in California)



Experience: Minimum 3 years



Primary Purpose: The Workers' Compensation Claims Specialist will analyze and manage complex workers' compensation claims, ensuring adherence to service expectations, industry standards, and client requirements. This role involves handling claims involving litigation, rehabilitation, subrogation, and settlements.



Essential Functions and Responsibilities:

• Analyze and process complex workers' compensation claims, investigating to determine claim exposure.


• Develop action plans to manage claims towards timely and appropriate resolution.


• Negotiate settlements within designated authority.


• Calculate and assign reserves; manage reserve adequacy throughout the claim lifecycle.


• Calculate and process benefits; approve and adjust claim payments promptly.


• Prepare necessary state filings within statutory limits.


• Manage the litigation process to ensure cost-effective claims resolution.


• Coordinate vendor referrals for investigation and litigation management.


• Utilize cost containment techniques and strategic vendor partnerships to reduce claims costs.


• Manage claim recoveries, including subrogation and offsets.


• Report claims to excess carriers and respond to inquiries promptly.


• Maintain professional relationships with claimants and clients; communicate claim activity effectively.


• Ensure accurate documentation and coding of claim files.


• Refer cases to supervisors and management as appropriate.

Additional Functions and Responsibilities:

• Perform other duties as assigned.


• Support the organization's quality program(s).


• Travel as required.

Qualifications:

• Minimum high school diploma or equivalent (Bachelor's degree preferred).


• Professional certification applicable to the line of business preferred.


• Five (5) years of claims management experience or equivalent combination of education and experience.


• Strong knowledge of insurance principles and laws related to workers' compensation.


• Familiarity with recoveries, offsets, and deductions.


• Proficiency in claim and disability duration management.


• Understanding of medical management practices and Social Security/Medicare application procedures.


• Excellent communication skills (written and verbal); strong negotiation skills.


• Proficiency with Microsoft Office products; PC literate.


• Analytical, organizational, and interpersonal skills.


• Ability to work effectively in a team environment and meet service expectations.

Work Environment:

• Mental: Clear thinking, judgment, problem-solving ability, and ability to handle multiple priorities.


• Physical: Computer keyboarding; occasional travel may be required.


• Auditory/Visual: Normal hearing, vision, and speaking abilities.

Benefits:



BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.



About BCforward:



Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.


BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.


BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.


To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.


This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.


Interested candidates please send resume in Word format Please reference job code 224993 when responding to this ad.


Get job alerts by email.Sign up now!Join Our Talent Network!



Job Snapshot




Employee Type

Contractor



Location

Orange, CA (Onsite)



Job Type

Biotech



Experience

Not Specified



Date Posted

07/23/2024 Apply Now