Claims Examiner, Workers Compensation

BETA HEALTHCARE GROUP RISK MANAGEMENT•Roseville, CA

1d•Hybrid

About The Position

We are looking for a new Claims Examiner to add to our Workers’ Compensation team! We are a fun, fast-paced team who work hard for our members. Are you driven by the ability to set and exceed results-orientated goals? Are you organized, detail-orientated, and can communicate effectively? Do you do well under pressure or changing priorities? If you are interested in building your career in Workers' Compensation Claims Management, our team is looking for you! ABOUT BETA HEALTHCARE GROUP: BETA Healthcare Group (BETA) is the largest professional liability insurer of hospitals on the west coast, providing coverage to more than 600 hospitals and healthcare facilities and provides workers' compensation coverage for over 90,000 healthcare workers in California. BETA also has a long-established and growing commitment to physicians, providing medical professional liability coverage to nearly 7,700 physicians and more than 70 medical groups. Beyond primary liability and workers’ compensation coverage, BETA provides an entire suite of alternative risk and insurance services, including excess healthcare professional liability coverage, excess workers’ compensation coverage, third-party claims administration services, risk management consulting services and claims management consulting services. Whether with hospitals, medical groups, clinics or hospices, BETA has earned a reputation for financial strength, rate stability, quality service and breadth of coverage that is unparalleled in the industry. ABOUT THE ROLE: In this role, you will manage all aspects of claims to include gathering information necessary to make informed and responsible decisions to bring claims to appropriate resolution. Under general supervision, develop and carry out a plan of action for claim resolution consistent with statutory requirements and client specifications. Establish reserves and work in concert with employers, employees, medical providers, attorneys and other vendors to maximize cost-effective claim management. This is an exempt position, allows telecommuting up to 2 days a week from home after a training period and must be a commutable distance to our Granite Bay, CA office.

Requirements

High school diploma or G.E.D. required; Bachelor’s degree preferred
Minimum one (1) years’ experience as a workers’ compensation examiner or equivalent
Knowledge of claims management techniques, including investigation, reserving, cost analysis, and case resolution techniques
Strong customer focus with a strong sense of urgency and attention to detail
Excellent organizational skills
Manage multiple simultaneous projects; working independently in a multi-tasking office setting
Proficient with Microsoft Office and be able to learn and utilize specialty software systems and procedures
Must have excellent verbal and written communication skills including the ability to proofread the work of self and others with a high degree of accuracy
SIP license required or achieved within 6 months of promotion or hire
Meet the ongoing training or experience requirements set forth in regulations California Code of Regulation (Article 20 of subchapter 3, chapter 5, Title 10) and (Section 2592.01[f])

Responsibilities

Evaluate claims and determine course of action from inception to resolution timely and accurately
Gather and analyze information including medical, legal, and factual evidence to determine compensability of claim
Evaluate claims to determine appropriate use of independent medical evaluations for claims and/or refer to legal
Evaluate all information to make appropriate determination on compensability and issue compensability decisions
Manage and direct action of diary, e-mail, mail, faxes, phone calls, payments, required benefit notices, etc. to move claim to the best financial outcome and timely resolution
Evaluate and establish medical, legal, vocational rehabilitation, and indemnity reserves based on facts of case and probable exposure, including reporting to excess carrier, within authority level
Evaluate and determine an appropriate negotiated settlement amount, within authority level
Communicate, strategize and direct legal counsel regarding issues such as discovery, depositions, settlement value
Provide superior claims processing and diary management as exhibited by appropriate reserves, timely payments, reports, contacts, closings and activity on the claim files
Represent the company as needed in depositions, conferences, hearings and trials
Travel may be required periodically, which may include overnight stays and/or transportation via airplane
All other duties as assigned or as situation dictates