Works independently to manage Workers' Compensation cases, including complex and catastrophic claims.

Note commercial Workers' Compensation experience in California is required.

DISTINGUISHING CHARACTERISTICS:

Administers complex non-litigated and litigated workers’ compensation cases and integrates the delivery of benefits associated with sickness and long-term disability benefits.  Provides technical guidance, mentoring and support to claims assistants and clerical staff.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To perform this job successfully, the employee must be able to efficiently and effectively perform each of the following essential functions.  Reasonable accommodation may be made for individuals with disabilities.

The functions of this job include but are not limited to;           

• Set up claims and make timely three point contacts
• Ensure the privacy and security of Protected Health Information (PHI)
• Analyze claim, investigate and estimate proper reserves
• Develop and maintain relevant plan of action
• Set up and maintain timely benefit payments (Includes wage statement calculation and diary management)
• Identification and pursuit of subrogation
• Timely review and maintenance of incoming mail
• Timely response to Request for Authorization or referral for Utilization Review
• Consistent communication and claim reviews with all parties, including our Claims Services Account Manager in relation to brokers and policy holders.
• The agricultural accounts are generally higher volume policies, fast-paced and seasonal,  and special handling is oftentimes required.
• Timely evaluation of reserve adequacy
• Proactively maintaining current status of claims
• Identify, rate and reserve for possible permanent disability
• Evaluate claim for settlement purposes
• Timely excess Carrier Reporting
• Close cases in a timely and expedient manner
• Other duties as may be assigned
• Must be able to work at least 40 hours per week, Monday thru Friday and be available to work extended hours as situations arise.

• Requires 3 to 5 years of commercial Workers’ Compensation experience
• Any combination equivalent High School graduation and/or two year community college or experience in business or closely related field.
• Litigated and non-litigated claims experience required.
• Basic mathematical skills required for calculations and ratings.
• Knowledge and understanding of workers’ compensation claims administration required.
• Through knowledge of Self-Insurance regulations, Case Law, Labor Code.
• Must possess strong time management, organization and problem solving skills.
• Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.
• Ability to write letters, memos and reports that conform to prescribed style, format and grammatical correctness.
• Ability to effectively present information to top management.
• Extensive clear and tactful communications required via writing, reading, telephone calls, note taking, letter writing, memoranda, etc.
• Must be able to negotiate.
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages. 
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
• Must be Current on Worker’s  Compensation education training hours.

Your employer reserves the right to modify the description of the duties and the requirements of this job at any time upon reasonable notice.

The expected salary range for this role is $87,600-$95,000.00. 

Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.

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