Hybrid Claims Representative - Workers Compensation
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The Opportunity
Description
We're looking for a Hybrid Claims Representative - Workers Compensation, working in Insurance industry in 1320 Willow Pass Road 2nd Floor, Suite 60 and 1st Floor, Suite 80 , Concord, California, United States.- Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
- Manage claims through well-developed action plans to an appropriate and timely resolution.
- Negotiate settlement of claims within designated authority.
- Calculate and assign timely and appropriate reserves to claims.
- Manage reserve adequacy throughout the life of the claim.
- Calculate and pay benefits due.
- Approve and make timely claim payments and adjustments; and settles clams within designated authority level.
- Prepare necessary state fillings within statutory limits.
- Manage the litigation process.
- Ensure timely and cost-effective claims resolution.
- Coordinate vendor referrals for additional investigation and/or litigation management.
- Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
- Report claims to the excess carrier.
- Respond to requests of directions in a professional and timely manner.
- Communicate claim activity and processing with the claimant and the client.
- Maintain professional client relationships.
- Ensure claim files are properly documented, and claims coding is correct.
- Refer cases as appropriate to supervisor and management.
- Perform other duties as assigned.
- Support the organization's quality program(s).
Our Client
Our client is a leading provider of comprehensive workforce and outsourcing solutions. With over 70 years of experience, they specialize in offering a wide range of services including consulting, staffing, recruitment, human resource management, vendor management, and outplacement.
Having established a global presence, our client has successfully catered to the needs of numerous Fortune 100 companies. They excel in providing staffing solutions for various sectors such as office services, call centers, light industrial, and electronic assembly.
Their commitment to delivering the highest quality workforce solutions is reflected in their strong reputation. They strive to offer the best opportunities to every candidate and ensure that organizations receive the most suitable workforce. This is achieved through their dedication to exceptional service, teamwork, and unwavering integrity.
Experience Required for Your Success
- Bachelor’s degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred
- 5 years of claims management experience or equivalent combination of education and experience required
- Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Good interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Service Expectations
- When applicable and appropriate, consideration will be given to reasonable accommodation
- Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
- Physical: Computer keyboarding, travel as required
- Auditory/Visual: Hearing, vision and talking
What Do You Think?
Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible?
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