Claims Examiner - Workers Compensation
LWP Claims Solutions, Inc. - Sacramento, CA

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LWP Claims Solutions, Inc. is a claims management company dedicated exclusively to workers' compensation programs. We have full service offices in Sacramento and Glendale, California. Founded in 1990, LWP is known for outstanding quality claims services for clients interested in services tailored to their specific needs. Through a combination of our claims handling expertise, prompt and fair benefit administration, consulting and training techniques, and team-based relationships with our clients, LWP has been successful in assisting our clients in achieving some of the lowest loss development rates in the industry.

POSITION: Claims Examiner (full time, Sacramento location)

Promptly and properly addresses all claims issues to include compensability, temporary disability, permanent disability, apportionment, contribution, subrogation, medical management, rehabilitation and litigation. Utilizes ongoing contact with employers, employees, medical and other outside providers to maximize a cost-effective case resolution.

ESSENTIAL FUNCTIONS AND BASIC DUTIES
1. Assumes responsibility for the effective handling of claims / files.
a. Promptly investigate and evaluate areas of discrepancies or inconsistencies from initial notice of loss through claim conclusion.
b. Administer benefits timely and accurately pursuant to State Law, Statues and/or Regulations.
c. Handles claims consistent with LWP Best Practices.
d. Issues benefit letters or state notices timely and correctly pursuant to State Law, Statues and/or Regulations.
e. Maintains a current plan of action at all times, and ensures that plan is being followed.
f. Utilizes proactive medical management to facilitate file closure.
g. Manages and provides direction to all vendors associated with the claim file.
h. Maintains reserves on each claim that reflect the likely case outcome.
i. Evaluates permanent disability and develops appropriate settlement.
j. Stays current on claim diary system.

2. Assumes responsibility for maintaining effective communication with internal and external contacts.
a. Initiates and maintains a good rapport with new and existing clients.
b. Attends client claim reviews as requested.
c. Reports claims to employers, brokers, carriers, or other designated program managers consistent with the claims handling guidelines of that client.
d. Seeks approval or authority from employers, brokers, carriers, or designated program managers for reserves, settlements, litigation, vendor referrals or any other items documented in the claim handling instructions.
e. Provides a claim status report on any claim(s) as requested by the client.
f. Works with Management Team and Support staff to ensure work is completed timely and accurately.
g. Continually fosters a teamwork spirit.
h. Provides back up or assistance for the claims unit, as requested.
i. Communicates to direct supervisor any workflow problems, issues or backlog immediately.
j. Acknowledges and acts upon requests from any member of the management team with 48 hours, or by agreed upon deadline.

QUALIFICATIONS

EXPERIENCE REQUIRED:
High school diploma
Six to twelve months work experience in the insurance, legal or health care industry
IEA Certification or equivalent training/work experience
Self-Insurance Certificate
Labor Code 4850 experience preferred

SKILLS/ABILITIES:
Effective interpersonal skills.
Well-organized and attentive to detail
Excellent oral and written communication skills.
Able to meet deadlines and manage projects.
Effective problem resolution and negotiation skills.
Able to handle multiple tasks in a high-pressure environment.
Intermediate spreadsheet and word processing skills.
Strong analytical skills.
Ability to operate computer, calculator, printer, copier, facsimile and other general
office equipment.

SKILLS/ABILITIES:
Effective interpersonal skills
Well-organized and attentive to detail
Excellent oral and written communication skills
Able to meet deadlines and manage projects
Effective problem resolution and negotiation skills
Able to handle multiple tasks in a high pressure environment
Intermediate spreadsheet and word processing skills
Strong analytical skills
Ability to operate computer, calculator, printer, copier, facsimile and other general office equipment
Handles WCAB and Rehab Unit conferences independently
Handles Client Claim Reviews independently
Able to rate all levels of permanent disability without outside assistance

Must meet the training or experience requirements per California Code of Regulation (Article 20 of Subchapter 3, Chapter 5, Title 10)

Labor Code 4850 experience preferred

No phone calls please. Only applicants invited to interview will be contacted. EOE