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Workers Compensation Specialist (Temp Assignment)

The Workers' Compensation Claims Specialist is responsible for proactively managing and finalizing cases to protect the interest of the injured employee and client; timely and accurate claims processing of all client claims from filing to closure in accordance with the company's best practices and state regulations. In addition, the Claims handler will work closely with the injured employees, insurance claims personnel, medical providers, and defense and applicant attorneys. Negotiate settlements to achieve the best possible outcome for each claim.
Job Qualifications:
Bachelors Degree Preferred
3 or more years of Workers' Compensation Claims Handling experience
A thorough functional knowledge and skill of claims handling.
Fundamental knowledge of the insurance industry, claims and the insurance legal and regulatory environment
ESSENTIAL DUTIES:
Ensure timely and accurate liability decisions and benefit provisions.
Initiate "Three-Point Contact" with client, injured employee and medical provider.
Initiate, coordinate and ensure early return-to-work efforts with worker and client management team.
Proactively manage, finalize, and control cases.
Authorize medical treatment within pre-established authority level.
Review, investigate, analyze, and adjust workers' compensation claims in accordance with current laws and regulations.
7. Report on claim reserves to client management team on a regular basis and work with insurance claims personnel to ensure cost exposure
Review progress of claims with client, providing a well documented action plan and acting as a resource for claims questions and guidance.
As applicable, authorize appropriate payments of medical bills, temporary and permanent disability benefits
Review and process bills for payment in accordance with the established fee schedule and contractual agreements.
Attend conferences and hearings necessary to properly administer resolution of claims.
Coordinate resolution of claims by preparing legal documents, including Stipulations, and Compromise and Release settlements within authority limits
Coordinate with defense counsel on litigated claims, providing records and reports, as necessary.
Refer appropriate claims for potential subrogation recovery.
Regularly handles private and proprietary information while maintaining strict confidentiality and protecting from unauthorized disclosure.
Stay apprised of current law changes, court rulings and related matters that might affect the handling of claims.
Performs various routine clerical duties, utilizing standard office equipment to include: maintaining calendars; entering information into databases and spreadsheets; making photocopies; faxing documents; typing; and word processing.
May require overnight travel to attend training, meetings, and claims reviews.
Keep Director of Human Resources apprised of any and all claims requiring special attention, or that have involve extenuating circumstances.
Perform other duties as assigned by Director of Human Resources.
KNOWLEDGE & SKILLS:
Knowledge of the entire claims administration, case management and cost containment solutions as applicable to Workers' Compensation rules in California.
PC literate, including Microsoft Office (Word, Excel)
Effective analytical and interpretive skills
Strong organizational & interpersonal skills
Ability to work in a team environment
Ability to work independently
Excellent oral and written communication skills
Please include your cover letter, resume and salary requirements.

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