Claims Examiner - Brea, United States - Cynet Systems

    Cynet Systems
    Cynet Systems Brea, United States

    1 month ago

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    Description
    Job Description:

    Pay Range $40hr - $ 46hr
    • nalyzes 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 clams 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 and/or litigation management.
    • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce 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 of 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.
    Qualification Education And Licensing:
    • Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
    Experience:
    • Five (5) years of claims management experience or equivalent combination of education and experience required.
    Skills And Knowledge:
    • Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, 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.
    • nalytical and interpretive skills.
    • Strong organizational skills.
    • Good interpersonal skills.
    • Excellent negotiation skills.
    • bility to work in a team environment.
    • bility to meet or exceed Service Expectations.
    Work Environment:
    • When applicable and appropriate, consideration will be given to reasonable accommodations.
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