Yoh is actively seeking candidates for a full time contract position for a Workers Compensation Claims Examiner III to join our client in Encino, CA.
Must Have Experience
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
- Assesses liability and resolve claims within evaluation.
- Negotiates settlement of claims up to designated authority level.
- Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
- Prepares necessary state filings 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 recoveries and Social Security 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 ill or injured party and the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
Skills and Knowledge:
- Baccalaureate degree from an accredited college or university preferred.
- Licenses as required. Professional certification as applicable to line of business preferred.
- Must have Four (4) years of claims management experience (required).
Discover all that's possible with Yoh. Apply now.
- In-depth knowledge 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 application procedures 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.
- Excellent negotiating skills.
- Good interpersonal skills.
- Ability to work in a team environment.
Recruiter: Jennifer Yerkes
Yoh is a professional staffing provider with over 70 years of experience in the short- and long-term staffing services industry; visit our website to learn both about our company and about our leading staffing solutions .
Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.
Yoh Services, LLC - 21 months ago
Yoh Company is a unit of Yoh, one of the largest staffing services firms in the United States with more than 550 million USD in total...