Claim Examiner – Workers’ Compensation (remote)
Location: Must reside in the state of California
Pay: Depends on experience
Duties of the Claim Examiner – Workers’ 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.
Skills Required for the Claim Examiner - Workers’ 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.
