Classification: Claims Administrator
Compensation: $18.00 to $22.00 hourly
Are you an experienced workers compensation claims professional that is looking for career growth and a chance to join a dynamic and growing company? Do you seek to join a team that produces exceptional work and meets the highest standards in a positive, supportive work environment?
Robert Half has an immediate opportunity for experienced workers compensation claims professionals in San Francisco, CA. Our client is dedicated to being the best workers compensation insurance company by providing compassionate care to injured workers, superior service to our customers and compelling opportunities for our employees. They have earned an enviable record of success and growth in the insurance industry while growing a culture centered around inclusion and collaboration. We pride ourselves on maintaining our small company feel and recognize that attracting and retaining high quality talent is essential to the success of our company.
As a Claims Professional, you will manage a caseload of Workers Compensation indemnity claims from inception to resolution. This position requires a self-starter who can work under a minimum of direction, achieve defined results and accept ownership for their work product.
•Conducts and directs the investigation of reported claims to determine coverage, compensability and severity and to gather all other relevant information, including making three-point contact telephone calls.
•Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
•Calculates and pays benefits in accordance with the law. Ensures that the claim as a whole is managed in accordance with all legal requirements including the issuance of appropriate notices and filings.
•Develops and updates a plan of action for the successful resolution of each claim.
•Makes prompt, sound decisions on issues that arise in claims based on the best information available.
•Ensures that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim.
•Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently.
•Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
•Reduces fraud through early identification and escalation.
•Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers.
•Fosters a positive and close working relationship with other Company staff, including the call center, medical management, special investigations, legal, and nurse case management.
•Ensures continual education requirements are met.
•Performs special assignments and projects as assigned.