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Worker's Compensation Claims Examiner

Company: Gables Search Group
Location: Pasadena
Posted on: June 5, 2021

Job Description:

Worker's Compensation Claims Representative
Contract / Temp-to-Hire 
Los Angeles, CA 
Ability to work remotely if located in Southern CA
Pay Rate: 35-42/hr.  
Assignment Duration 90 days (Temp to Hire) 
SUMMARY: To adjust assigned workers’ compensation lost time claims within delegated limits of authority, conduct timely and thorough investigations, and complete fair and equitable claim settlements in accordance with Claim Handling Guidelines that will ensure that services are provided in a fair, equitable and timely manner.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
• Receive new claim assignments. Analyze the nature of the claim to determine required investigation and handling. Determine and identify coverage issues or questions of compensability in accordance with the Claims Handling Guidelines.
• Perform timely and thorough investigations in an effort to comply with all jurisdictional requirements and/or entitlements
• Conducts an informed case analysis to address claim entitlements. Initiate reserve changes within assigned authority, makes recommendations to supervisor or manger where assigned authority is exceeded
• Manage, control and negotiate timely and equitable claim payments and settlements in accordance with jurisdictional and fair claims practices requirements and company policy and procedures.
• Investigate, evaluate and resolve moderate level litigated files including all aspects of litigation management in accordance with the Claims Handling Guidelines.
• Maintain current case diary and ensure appropriate hard copy file documentation. Provide accurate claims system documentation as required by company claim manuals and procedures. Responsible for completion and/or submission of claim forms and reports as required by outside agencies.
• Investigate and evaluate recovery potential. Conduct timely and thorough subrogation investigation in accordance with company policy and procedures. Timely completion and referral of all claims involving recovery potential.
• Service the claim needs of our customers, including insureds, claimants, brokers etc. in accordance with company policy and procedures.
• Partner with internal and external customers to bring about an appropriate claim resolution in a timely and effective manner in accordance with the Claims Handling Guidelines.
• Other Duties as assigned
• Bachelor's degree (B. A.) preferred
• 3+ years related WC claims experience Completion of insurance and/or claims courses preferred (IAA, AEI, CPCU)
• Knowledge of CA WC laws.
• Must have excellent attention to detail and organizational skills.
• Must have excellent follow-up skills to ensure required responses are received and work gets accomplished in a timely manner.
• Must have excellent customer service skills to ensure our internal clients are serviced professionally, effectively and in a timely manner.
• Must have strong computer skills including MS Office skills including Word, Excel (the ability to create and format spreadsheets, sort, and create basic formulas), and the ability to learn and implement other softwares.

Keywords: Gables Search Group, Pasadena , Worker's Compensation Claims Examiner, Other , Pasadena, California

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