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

Job Description:

Claims Examiner - Workers Compensation



BCforward is currently seeking a highly motivated Claims Examiner - Workers Compensation for an opportunity in Remote!




Position Title: Claims Examiner - Workers Compensation



Location: Remote

Anticipated Start Date: 10/21/20242


Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.



Expected Duration: 2 months



Job Type: FULL TIME (>=30 HRS WEEKLY, [CONTRACT], [REMOTE]

Pay Range: [$40.00] - [$46.42]


Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

Requirements:

• Claims Management


• SIP Certificate


• Workers Compensation

Job Description:


Job Description:



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.



ESSENTIAL FUNCTIONS and RESPONSIBILITIES



Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.


Develops and manages 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.



ADDITIONAL FUNCTIONS and RESPONSIBILITIES



Performs other duties as assigned.


Supports the organization's quality program(s).


Travels as required.



QUALIFICATIONS



Education & Licensing Bachelor's degree from an accredited college or university preferred.


Experience Four (4) years of claims management experience or equivalent combination of education and experience required.



Skills & Knowledge Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business


Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products


Analytical and interpretive skills


Strong organizational skill


Good interpersonal skills


Excellent negotiation skills Ability to work in a team environment


Ability to meet or exceed Service Expectations



WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Qualifications:



Min 3 Years of CA claims handling experience required. Remote in CA preferred. If candidate is from other state, 3 years of CA Claims handling experience is must. SIP is preferred not mandatory.



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.

Keywords:



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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 230316 when responding to this ad.


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Job Snapshot




Employee Type

Contractor



Location

Orange, CA (Onsite)



Job Type

Insurance



Experience

Not Specified



Date Posted

10/14/2024 Apply Now