Job Summary:

Responsible for managing an assigned number of Workers’ Compensation claims, ensuring adherence to government regulations, timely, accurate and cost-effective management and settlement of each case. May serve as department expert in training staff and management.

Job Duties:

Responsibilities included but are not limited to:

• Provide superior customer service by returning a telephone calls and email correspondence within a timely manner and answering callers’ basic questions regarding claims.
• Determine and resolve issues of coverage, compensability and liability, in order to delay, accept or deny claims within the statutory time constraints.
• Administer benefits of temporary disability, permanent disability, vocation rehabilitation and medical treatment in compliance with the CA State Workers’ Compensation Laws, Federal Laws and company guidelines
• Prepare claims defense to mitigate liability by effectively using defense medical evaluations, QMEs, AMEs, investigations, depositions, and to pursue subrogation where applicable
• Review all files on a 30 day diary, addressing reserves, mail, issue identification, strategy development, follow-up and aggressive action.
• Participate in negotiation process by attending hearings and providing deposition and testimony to ensure cost effective resolution of each case
• Interact and effectively communicate via telephone, electronic, and written correspondence with claimants, attorneys, doctors, counselors, investigators, agents, and insureds.
• Interact and effectively communicate and work with team members, Supervisors, Management and others, demonstrating professional courtesy at all times
• Continue training and development (seminars, classes) to keep abreast of changing laws and procedures and to enhance file handling techniques.
• Maintain certification and licensing as required by CA law
• Serve as the liaison between the company and the insured, and conduct regular claims reviews with the insured and broker
• Advise Examiners and Assistants on technical questions

Requirements: