Workers Compensation Claims Examiner
Location: Livingston, CA |
Shift: Days |
Status: Hourly |
Job ID: 27533
Essential Job Functions
1. Responsible for proactive case management of assigned workers’ compensation claims files.
2. Determines financial exposure and sets case reserves on assigned cases, reevaluates and adjusts reserves within assigned authority according to changing circumstances and in accordance with departmental guidelines and state regulations.
3. Notifies claim manger and supervisor regarding reserve changes.
4. Provides a reserve analysis and reports to claim manager for reserve changes over authority.
5. Maintains a proactive diary each assigned claim file, creates plans of action to facilitate resolution of the claims.
6. Authorizes appropriate medical treatment and payment in compliance with state regulations. Maintains compliance with Utilization Review, and MPN regulations.
7. Uses services of Utilization Review contractors, Medical Services, and case management nurses in accordance with departmental guidelines.
8. Responsible for notifying HR dept regarding surgery dates, disability info, etc. Authorizes or initiates medical referrals, second opinions, and AME QME exams.
9. Analyzes appropriate medical reports from physicians, Qualified Medical examiners, and Agreed Medical Examiners. Rating permanent disability according to State regulations and AMA guides.
10. Issues benefit payments and state required notices in compliance with the Workers’ Compensation regulations, as concerns disability benefits, rehab issues, objections, etc.
11. Proactively directs and manages defense attorneys on litigated files. Negotiates settlements with injured workers and applicant attorneys within assigned authority and prepares settlement documents.
12. Responsible for completion of Stipulations or C&R’s and obtaining employee signatures and approval of the Workers’ Compensation Appeals Board. Appearances at the Workers’ Comp Board as needed.
13. Diaries files timely and appropriately and reviews and documents all mail in a timely manner.
14. Provides 90 day status reports on all files.
15. Conducts file reviews with plant management as required.
16. Attends formal training in compliance with state regulations.
1. Requires thorough working knowledge of California Workers’ Compensation Laws, regulations, and case law.
2. Two years case management experience handling all levels of claims highly preferred.
3. Must qualify as an “experienced examiner” as defined by California Workers’ Compensation regulations.
4. Requires WCCA certification or equivalent training.
5. Requires strong analytical skills, verbal and written communication skills and good interpersonal skills.
6. Requires strong case management skills.
7. Must be detailed oriented, well organized and dependable.
8. Must be able to work in fast paced environment and handle multiple tasks with professionalism, tact and composure.
How To Apply
If you are interested in this position, please send your resume to email@example.com.
Or mail your resume to:
Foster Farms Central Employment
P.O. Box 457
Livingston, CA 95334
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