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WC Claims Examiner and/or Sr Claims Examiner

LWP Claims Solutions

WC Claims Examiner and/or Sr Claims Examiner

Glendale, CA
Full Time
Paid
  • Responsibilities

    Job Description

    LWP Claims Solutions, Inc. – Glendale, CA

    POSITION TITLE: Claims Examiner (CE) – Require 2+ Years CA WC Adjusting Experience POSITION LOCATIONS: Sacramento, Walnut Creek and Glendale, CA POSITION SUPERVISES: None POSITION SALARY WC CLAIMS EXAMINER/SR CE GLENDALE CA: DOE EXPERIENCE: 2-3 years

    POSITION PURPOSE Need detail oriented CE who promptly and properly addresses all claims issues to include compensability, temporary disability, permanent disability, apportionment, contribution, subrogation, medical management, rehabilitation and litigation. Utilizes ongoing contact with employers, employees, medical and other outside providers to maximize a cost-effective case resolution.

     

    ESSENTIAL FUNCTIONS AND BASIC DUTIES

    1. ASSUMES RESPONSIBILITY FOR THE EFFECTIVE HANDLING OF CLAIMS / FILES. a. Promptly investigate and evaluate areas of discrepancies or inconsistencies from initial notice of loss through claim conclusion. b. Administer benefits timely and accurately pursuant to State Law, Statues and/or Regulations. c. Handles claims consistent with LWP Best Practices. d. Issues benefit letters or state notices timely and correctly pursuant to State Law, Statues and/or Regulations. e. Maintains a current plan of action at all times, and ensures that plan is being followed. f. Utilizes proactive medical management to facilitate file closure. g. Manages and provides direction to all vendors associated with the claim file. h. Maintains reserves on each claim that reflect the likely case outcome. i. Evaluates permanent disability and develops appropriate settlement. j. Stays current on claim diary system.

    2. ASSUMES RESPONSIBILITY FOR MAINTAINING EFFECTIVE COMMUNICATION WITH INTERNAL AND EXTERNAL CONTACTS. a. Initiates and maintains a good rapport with new and existing clients. b. Attends client claim reviews as requested. c. Reports claims to employers, brokers, carriers, or other designated program managers consistent with the claims handling guidelines of that client. d. Seeks approval or authority from employers, brokers, carriers, or designated program managers for reserves, settlements, litigation, vendor referrals or any other items documented in the claim handling instructions. e. Provides a claim status report on any claim(s) as requested by the client. f. Works with Management Team and Support staff to ensure work is completed timely and accurately. g. Continually fosters a teamwork spirit. h. Provides back up or assistance for the claims unit, as requested. i. Communicates to direct supervisor any workflow problems, issues or backlog immediately. j. Acknowledges and acts upon requests from any member of the management team with 48 hours, or by agreed upon deadline.

    QUALIFICATIONS AND EXPERIENCE

    Bilingual

    ADR Experience preferred but not required.

    EDUCATION/CERTIFICATION: High school diploma (2 and/or 4 year degree a plus) IEA Certification or equivalent training/work experience Self-Insurance Certificate

    EXPERIENCE REQUIRED:

    Six to twelve months work experience in the insurance, legal or health care industry.

    Public Entity/Municipality experience a plus (LC 4850 and Presumption)

    Litigation experience.

     

    SKILLS/ABILITIES: Effective interpersonal skills Well-organized and attentive to detail Excellent oral and written communication skills Able to meet deadlines and manage projects Effective problem resolution and negotiation skills Able to handle multiple tasks in a high pressure environment Intermediate spreadsheet and word processing skills Strong analytical skills Ability to operate computer, calculator, printer, copier, facsimile and other general office equipment Handles WCAB and Rehab Unit conferences independently Handles Client Claim Reviews independently Able to rate all levels of permanent disability without outside assistance

    Must meet the training or experience requirements per California Code of Regulation (Article 20 of Subchapter 3, Chapter 5, Title 10)

     

    In accordance with the American with Disabilities Act, it is possible that requirements may be modified to reasonably accommodate disabled individuals. However, no accommodations will be made which may pose serious health or safety risks to the employee or others or which impose undue hardships on the organization. Please no phone calls. Only applicants invited to interview will be contacted. EOE

    Company Description

    LWP Claims Solutions, Inc. is a third party administrator dedicated exclusively to workers' compensation programs. We have full service offices in Sacramento and Glendale, California with financial services in Salt Lake City, UT. Founded in 1990, LWP is known for outstanding quality claims services for clients interested in services tailored to their specific needs. Through a combination of our claims handling expertise, prompt and fair benefit administration, consulting and training techniques, and team-based relationships with our clients, LWP has been successful in assisting our clients in achieving some of the lowest loss development rates in the industry.