Senior Claims Examiner, WC Details

Senior Claims Examiner, WC

AssuredPartners - Riverside, CA

Employment Type : Full-Time

Overview:
Administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation.

Responsibilities:
AP Keenan, an AssuredPartners company, is a successful insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. AP Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. We have seen continuous growth and success, and are positioned to lead the industry into the 21st century. Together, with AssuredPartners, we continue to grow at a rapid pace, and so do the opportunities for our current and future employees.

This is a remote position operating on Pacific Time.

SUMMARY: Administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Maintain current diary.
• Identify, prevent and mitigate potential penalties.
• Update claim notes in computer.
• Provide timely reporting of excess files to the Reinsurance Manager.
• Report SIU/Fraud.
• Identify and pursue subrogation.
• Complete Rehab forms/benefit notices/SJDB/RTW form.
• Refer all PRIME deletions only to office designee.
• Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim.
• Prepare for and attend file reviews.
• Accept or deny delayed claims within 90 days.
• Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date.
• Complete Stipulation and/or Compromise and Release paperwork.
• Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually.
• Prepare legal referrals, provide direction to and monitor defense attorney.
• Return all phone calls within 24 hours.
• Complete instruction sheets for Assistant/Technician/Claims entry clerk.
• Review mail daily.
• Correct error report daily.
• Maintain client/claimant satisfaction.
• Update Unit Stat forms.
• Oversee new set-ups, reserves and instruction sheets.
• Prepare cover letters to AME/defense QME, AOE/COE evaluations.
• Negotiate outstanding liens.
• Make 3-point contact.
• File Answer/Application.
• Interaction with nurse on case management.
• Other duties assigned.

MINIMUM SUGGESTED QUALIFICATIONS:

• Minimum of five (5) years of California Claims Examiner experience and a Self-Insurance Certificate required. WCCP preferred.
• Two (2) years of experience in handling school district claims is preferred.
• Effective in verbal and written communication.

SOFTWARE: Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required.