Claims Examiner

Date Posted: 02182025Hiring Organization: Rose InternationalPosition Number: 478383Job Title: Claims ExaminerJob Location: Long Beach, CA, USA, 90806Work Model: OnsiteEmployment Type: PermanentMin Hourly Rate($): 45.00Max Hourly Rate($): 50.00Must Have SkillsAttributes: Claims, Microsoft Office, Negotiation Job Description***This is a Direct hire role and is open for Office locations in Roseville and Long Beach, CA.***Education & Licensing:• A bachelor's degree from an accredited college or university is preferred. Professional certification as applicable to the line of business preferred.Experience:• 10+ years of claims management experience or equivalent combination of education and experience required.• To analyze complex or technically difficult workers'' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and to identify subrogation of claims and negotiate settlements.Skills & Knowledge:• Subject matter expert on appropriate insurance principles and laws for line-of-business handling, recoveries offsets and deductions, claim and disability duration, and 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 ExpectationsESSENTIAL FUNCTIONS and RESPONSIBILITIES:• Analyzes and processes complex or technically difficult workers'' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.• Negotiates settlement of claims within designated authority.• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.• Prepares necessary state fillings within statutory limits.• Manages the litigation process; ensures timely and cost-effective claims resolution.• Coordinates vendor referrals for additional investigation andor litigation management.• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce the overall cost of claims for our clients.• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.• Reports claims to the excess carrier; responds to requests for directions in a professional and timely manner.• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.• Ensures claim files are properly documented and claims coding is correct.• Refers cases as appropriate to supervisor and management.**Only those lawfully authorized to work in the designated country associated with the position will be considered.****Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client's business needs and requirements.** Benefits:For information and details on employment benefits offered with this position, please visit here. Should you have any questionsconcerns, please contact our HR Department via our secure website.California Pay Equity:For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department.Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 1310-91.).

Created: 2025-02-22