Senior Claim Representative

Job Description

Job Title : Workers’ Compensation Senior Claim Representative

Location : Los Angeles, CA 90071

Duration : 6 Months (Contract to Hire-CTH)

Job hours-8 : 00-4 : 30

Job schedule-40 hours on site

Interview process-WEBEX prescreen / Then in-person interview

Job Description : Client is currently seeking a Workers’ Compensation Lost Time Senior Claim Examiner for our West Coast / Pacific region. The successful applicant will be handling claims from California. The position will report and reside in our Los Angeles, CA

Duties & Responsibilities :

• Handles all aspects of workers’ compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
• Reviews claim and policy information to provide background for investigation.
• Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers.
• Evaluates the facts gathered through the investigation to determine compensability of the claim.
• Informs insureds, claimants, and attorneys of claim denials when applicable.
• Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc.
• Timely administration of statutory medical and indemnity benefits throughout the life of the claim.
• Sets reserves within authority limits for medical, indemnity and expenses and recommends reserve changes to Team Leader throughout the life of the claim.
• Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
• Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.
• Works with attorneys to manage hearings and litigation
• Controls and directs vendors, nurse case managers, telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.
• Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.
• Files workers’ compensation forms and electronic data with states to ensure compliance with statutory regulations.
• Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.
• Works with in-house Technical Assistants, Special Investigators, Nurse
• Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.

Technical Skills & Competencies :

Experience, Education & Requirements :