Sr. Claims Examiner (Pleasanton)

Sr. Claims Examiner (Pleasanton)

Sr. Claims Examiner (Pleasanton)
Location
Pleasanton CA
Department
Workers Compensation Claims
Description
"Insure" your future.
The Worker's Compensation Department is looking to add a Sr. Claims Examiner.

Our team provides innovative products and coverage solutions as well as professional and impartial claims handling. Join our team of skilled professionals that is dedicated to quality and superior customer service.

"Claim" your role.
Our Sr. Claims Examiner is a person who can represent the Worker's Compensation Department as well as ICW Group. You are well organized, you can resolve conflicts fairly and equitably and you have excellent written and oral communication skills. You will administer benefits to injured workers in accordance with statutory and case law as well as pertinent regulations and you will manage and bring Workers' Compensation claims to an equitable conclusion within the ICW Group standards and best practices guidelines.

Responsibilities include:
-Manage a case load of up approximately 125 files.
-Must oversee the work given to the designated Claim Assistant to ensure timely responses are made and that the work is accurate.
-Creates and adjusts reserves in a timely manner to ensure reserving activities consistent with company policies.
-Communicates with insureds to obtain information necessary for processing claims.
-Confers with legal counsel on claims requiring litigation. Attends depositions and hearings as often as workload allows.
-Contacts and/or interview claimants, doctors, medical specialists, or employers to get additional information.
-Examines claims investigated by outside adjusters, further investigating questionable claims to determine whether to authorize payments.
-Investigates, evaluates and settles claims, applying technical knowledge and human relations skills to ensure fair and prompt management of cases.
-Pursues subrogation vigorously.
-Participates in claim reviews and service calls with insureds and prospective insureds.
-Manages and approve payment of benefits within designated authority level.
-Presents cases and participate in their discussion at claim committee meetings.
-Reports overpayments, underpayments and other irregularities.
-Resolves claims fairly and equitably, acting in the best interest of the insured and providing benefits as prescribed by law.
-Reports overpayments, underpayments and other irregularities.
-Resolves claims fairly and equitably, acting in the best interest of the insured and providing benefits as prescribed by law.
-Creating and adjusting reserves in a timely manner to ensure reserving service standards.
-Investigating, evaluating and settling claims applying technical knowledge and human relations skills
-Examining claims investigated by outside adjusters

Requirements include:
-Associates degree or equivalent from two-year college or technical school Requires a minimum of 2-4 years of work-related skill and knowledge. All Examiners must receive certification that meets the minimum standards of training, experience and skill.
-Strong understanding of laws and jurisdictional restraints to manage injuries. WCCA and WCCP helpful.
-Excellent verbal and written communication skills, time management and organizational skills.
-Requires a high level of attention to detail.
-Team oriented and a sense of urgency for execution.