Claims Examiner
Company: ICONMA, LLC
Location: Rancho Cucamonga
Posted on: January 15, 2023
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Job Description:
Job Description+ 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:+ Analyzes
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.+ 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.
Requirements + Excellent oral and written communication, including
presentation skills.+ PC literate, including Microsoft Office
products.+ Analytical and interpretive skills.+ Strong
organizational skills.+ Good interpersonal skills.+ Excellent
negotiation skills.+ Ability to work in a team environment.+
Ability to meet or exceed Service Expectations. As an equal
opportunity employer, ICONMA prides itself on creating an
employment environment that supports and encourages the abilities
of all persons regardless of race, color, gender, age, sexual
orientation, citizenship, or disability.
Keywords: ICONMA, LLC, Rancho Cucamonga , Claims Examiner, Other , Rancho Cucamonga, California
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