Senior Workers Compensation Claims Examiner

Senior Workers Compensation Claims Examiner

The James Allen Companies Inc
September 17, 2019
Walnut Creek, CA
Job Type


Senior Workers Compensation Claims Examiner

Claims Department
Reports to the Vice President and Senior Vice President, Claims
Summary and Purpose
Investigate, manage and resolve claims in a timely, unbiased and informed manner in compliance with policies, state laws and regulatory performance standards.
General Responsibilities
• Knowledge of policy documents for coverage verification.
• Provide account servicing support on claim issues to policyholders to include travel as required.
• Investigate, determine compensability and manage time loss claims consistent with jurisdictional requirements.
• In-Person meetings with injured workers, employers, and medical providers
• When necessary, assign investigators, attorneys, medical consultants and others to facilitate claim determinations and plan of action.
• Follow up with claimants, policyholders and medical providers to monitor progress.
• Answer questions regarding the status of pending claims from claimants, policyholders and medical providers.
• Consult with attorneys regarding litigation management, settlement strategy and claim resolution.
• Manage the most complex claims.
• Assist clerical staff in completion of workers' compensation forms in conformance with jurisdictional requirements.
• Maintain electronic and paper files necessary for documentation of the claim file to include coding, contacts, financial data and plan of action.
• Review reserves for appropriateness and file timely reports on all serious loss claims as required by policy and regulatory standards.
• Work with management to develop ANIC policies when necessitated by statutory/regulatory changes.
• Provide mentoring and leadership to the claims department.
• Provide direction, assistance, and supervision to assigned clerical and adjusting staff.
• Develop curriculum and present training programs for claims adjusters and claims department.
• Promote the team approach to case and account management.
• Perform other duties as assigned.
Minimum Requirements
• High school graduate
• Two years of college preferred
• 10 years of Workers’ Compensation adjusting experience
• In-depth knowledge of Workers’ Compensation laws
• Knowledge of medical and legal terminology and procedures
• Mentoring and leadership experience
• General computer skills

Bilingual (Spanish and English) Major Plus

• Excellent written and verbal communication skills
• Strong interpersonal skills
• Effective negotiation skills
• Ability to prioritize workload to meet deadlines
• Ability to work well in a team environment

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