Workers' Compensation Claims Examiner

Pacific Claims Management is a client focused, third party administrator of workers' compensation claims. Our unique approach centers on the welfare of our client and is achieved by our drive to provide our staff with the right tools and opportunities for success. We are seeking an experienced workers' compensation claims examiner to join our team.

Pacific Claims Management offers its adjusters a generous benefit package that includes non-standard perks that we would love to speak with you about!

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Manages workers' compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

QUALIFICATIONS

Education & Licensing

• CALIFORNIA SELF-INSURED ADMINISTRATOR'S CERTIFICATE

Skills & Knowledge

• Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed service expectations

Remote available for qualified candidates. Hybrid remote available for qualified candidates.

Job Type: Full-time

Pay: Up to $100,000.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Vision insurance