Job Title: Workers’ Compensation Claims Analyst

Location: Remote Set up

Job Type: Full-time, Contract

Job Description:

We are seeking a skilled Workers’ Compensation Claims Analyst to join our team. The ideal candidate must have:

• A minimum of 3 years of relevant California Workers’ Compensation claims experience
  

• California WC Claims handling experience
  

• OSIP certification

The role involves analyzing complex or technically difficult workers’ compensation claims to determine benefits due, working with high exposure claims involving litigation and rehabilitation, and ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Additionally, you will identify subrogation of claims and negotiate settlements.

Primary Purpose:

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.

Essential Functions and Responsibilities:

• Analyze and process complex or technically difficult workers’ compensation claims by investigating and gathering information to determine exposure on the claim.
  

• Manage claims through well-developed action plans to an appropriate and timely resolution.
  

• Negotiate settlement of claims within designated authority.
  

• Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
  

• Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority level.
  

• Prepare necessary state fillings within statutory limits.
  

• Manage the litigation process; ensure timely and cost-effective claims resolution.
  

• Coordinate vendor referrals for additional investigation and/or litigation management.
  

• Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
  

• Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
  

• Report claims to the excess carrier; respond to requests of directions in a professional and timely manner.
  

• Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
  

• Ensure claim files are properly documented and claims coding is correct.
  

• Refer cases as appropriate to supervisor and management.

Additional Functions and Responsibilities:

• Perform other duties as assigned.
  

• Support the organization’s quality program(s).
  

• Travel as required.

Qualifications:

• Education & Licensing: Bachelor’s degree from an accredited college or university preferred. Professional certification as applicable to the line of business preferred.
  

• Experience: Three (3) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge:

• Subject matter expert in appropriate insurance principles and laws for the line-of-business handled, recoveries offsets, and deductions.
  

• Excellent oral and written communication, including presentation skills.
  

• PC literate, including Microsoft Office products.
  

• Analytical and interpretive skills.
  

• Strong organizational skills and good interpersonal skills.
  

• Excellent negotiation skills.
  

• Ability to work in a team environment.
  

• Ability to meet or exceed Service Expectations.

Work Environment:

• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem-solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
  

• Physical: Computer keyboarding; travel as required.
  

• Auditory/Visual: Hearing, vision, and talking.

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