Sr. Workers Compensation Claims Examiner

Your primary focus will be handling a high volume of workers' Compensation Claims originating from various locations. Your responsibilities will encompass the entire claims process, which is managed in-house, including researching, analyzing, investigating, evaluating reserves, and processing claims. You will be responsible for making claims determinations, engaging in negotiation activities, and preparing for district claim file review meetings. This role involves extensive interaction with a variety of professionals, including member districts, legal counsel, rehabilitation coordinators, medical evaluators, and investigators, often via high volumes of phone calls. Additionally, you will provide information to and collect information from these stakeholders, ensuring a smooth claims process.

Location: Pleasant Hill, CA (2 days on-site after the training). The initial 3 weeks is required 5 days on-site for training*

Duration: 4-6 months contract (possible extension or conversion)

Job Function Details:

•Performs the more complex and difficult claims examining activities for the Claims Department

•Handle high volume Workers Compensation Claims from various locations

•End to end management of the claims process (all handled in house) including researches, analyzes, investigates, evaluates reserves and processes claims

•Responsible for claims determination, negotiation activities, and preparation for district claim file review meetings

•High volume of phone calls including contracting professionals assisting in analyzing and researching claims including member districts, legal counsel, rehabilitation coordinators, medical evaluators and investigators; provides and collects information

•Educates claimants on the claims process; reviews laws, codes, and governmental regulations relative to Workers’ Compensation claims processing

•Participates in the authorization of complex payments to claimants, medical providers and vendors; issues checks and benefit payments

Requirements:

•3-5+ years as a Claims Examiner including experience working with claimants and professional contacts in the workers’ compensation area

•Claims Examiners are required to have state certification

•School/Education Workers Comp claims/education codes experience (huge plus)

•Basic medical terminology

Licenses or Certificates Required:

•Possession of Self-Insured Administrator’s Certificate issued by the State of California

•Must possess and maintain an Experienced Claims Adjustor Designation

Workers Compensation, Labor Law, Insurance (Disability), Benefits Administration, HR Compliance, Health Insurance