Claims Examiner III, Workers' Compensation / RSKM2073

Position Description:

The Northern California Division’s Workers’ Compensation Department, located in Pleasanton, California, has an opening for a Claims Examiner III.Qualifications:4 year college degree or equivalent work experience.Minimum of 5 years claims examiner experience.S.I.P. certification required. I.E.A. certificate.Advanced classes taken such as the IEA Labor Code and Case law, Advanced PD Rating or INS Supervisory classes or equivalent.Knowledge of the States Workers’ Compensation system principles, statutes and judicial protocol (benefit calculation, compensability decision time line factors, and sub rosa).Knowledge of hearing and trial process and procedures.Knowledge of OSHA and state reporting requirements.Ability to organize prioritizes and completes multiple objectives and be detailed oriented.Permanent disability systems and calculations.Excellent oral and written communication skills and math skills.Strong interpersonal, negotiation and customer service skills.Capable of dealing with demanding customers.Must be able to effectively work in a team environment.Self-starter who takes the initiative to solve problems within his/her authority.Computer literate and knowledge of computer claim applications and Microsoft Office Suite preferred.Met or exceeded examiner II management goals for 2 or more years. Key Responsibilities include, but are not limited to:Analyze each case assigned for all legal issues, and provides analysis and plan of action to claims examiner.Supports the supervisor in administration of the claims unit. Acts as a substitute for the supervisor during vacations or absences. Evaluate and maintain timely claim reserves.Provide timely and accurate benefits to the legitimately injured worker.Investigate (field or otherwise) all injuries, determine compensability of the claim, evaluate liability/exposure, identify and pursue subrogation and/or salvage and prepare proper reports as required.Manage medical treatment, medical utilization, authorize, control and process bills within guidelines by using cost containment program; audit provider bills.Work with injured workers, facility managers and physicians to aid in the return to full or modified work duties.Ability to recognize and manage the vocational rehabilitation process. Manage the litigation process. Develop settlement and negotiate strategies with attorneys and injured workers, execute settlement documents and issue settlement benefits as approved by the WCAB.Determine need for and direct defense counsel, independent examiners, or other experts and monitor and control their costs.Communicate and interact with facility managers, injured workers, attorneys, physicians, vendors, Disability Evaluation Bureau, WCAB, etc., as needed.Interact with Division and Corporate Departments to obtain information necessary to resolve claims, discuss safety awareness and understand contractual issues presented to the company.Identify and report all fraud.Salary: Grade 21.Salary and range will be commensurate with experience and qualifications.