Claim examiner Jobs in Oxnard ca

Contra Costa County Schools Insurance Group

Pleasant Hill, CA

Workers’ Compensation Sr. Claims Examiner

The Contra Costa County Schools Insurance Group (CCCSIG) is inviting applications from well-qualified individuals for the position of Workers’ Compensation Sr. Claims Examiner.   The Sr. Claims Examiner performs the most difficult and responsible types of duties assigned to classes within this series utilizing skills that require an understanding of the most complex claims, analytical procedures and processes, while working with a very high level of independent authority and judgement.

AN IDEAL CANDIDATE will be detail-oriented, accurate, organized, a team player and have good time management skills.   An ideal candidate will have experience with CA workers’ compensation, preferably working with education code.

COMPENSATION

The Sr. Claims Examiner salary is a 5-step range, $95,302.86—$115,841.22 / yearly. Placement on the salary schedule is dependent upon prior experience.   Additional compensation is provided for benefits through an IRC-125 Cafeteria Plan.

Employees earn 8 hours of vacation per month along with 14 paid holidays.   Full-pay sick leave is also earned at the rate of 8 hours per month. Retirement benefits are provided through the Public Employees Retirement System and   are not coordinated with Social Security.   PERS is an employee / employer contributory plan.

Only those applicants who have followed application procedures will be considered for this position.   Any applicant who attempts to directly contact individuals from the Agency with the intent of influencing the decision will be disqualified from candidacy.   CCCSIG is an EOE.

RESPONSIBILITIES INCLUDE (but are not limited to) :

• Leads, oversees and performs the more complex and difficult work of staff responsible for claims examination within the Claims Department..
• Administers the processing of claims; receives new claims; enters claim information into on-line claims system; sets up and maintains claim files and records.
• Contacts professionals assisting in analyzing and researching claims including member districts, legal counsel, rehabilitation coordinators, medical evaluators and investigators; provides and collects information.
• May provides leadership, direction and training to other members of the Claims Department assigned to the same district, ensuring adherence to policies and procedures established for the Claims Department; proper work methods, techniques and compliance with applicable standards and specifications.
• Takes statements from involved parties in claims including witnesses; educates claimants on the claims process; reviews laws, codes, and governmental regulations relative to Workers’ Compensation claims processing and maintains CCCSIG Best Practices.
• Analyzes medical records, reports and investigations; participates in the determination of claim acceptance or denial.
• Coordinates and analyzes the medical aspects of claim files for the determination of treatment and testing procedures; reviews medical reports to determine level of disability.
• Participates in the authorization of payments to claimants, medical providers and vendors; determines payment due dates of disability and rehabilitation claims; issues checks and benefit payments.
• Assesses the potential cost of claims; monitors assigned claims throughout the process.
• Negotiates settlements with claimants and attorneys for claims determination; denies claims as appropriate.
• Assigns and prepares files for litigation proceedings; maintains files with on-going litigation documents and claims correspondence; reviews file for closure; prepares proper correspondence for closure; closes out files.

ABILITY TO :

KNOWLEDGE OF :

EDUCATION / TRAINING & EXPERIENCE GUIDELINES :

Any combination of experience and training that would likely provide the required knowledge and abilities is qualifying.   A typical way to obtain the knowledge and abilities necessary are :

Experience :

Training :

Licenses or Certificates Required

Resumes can be emailed to [email protected]

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