Job Summary
Oversight of self-insured workers' compensation (WC) program. This is a complex position that has oversight for claim resolution in 41 state and 3 federal jurisdictions (Black Lung, Longshore & Jones Act). Key responsibilities include TPA oversight, annual/quarterly reporting obligations, audits, actuarial submissions, collateral oversight, and principal advisor/ liaison to regulatory agencies and business units. Requires specific WC claims administration experience as well as state regulatory and industry training, knowledge, and experience. Self-insurance certification required. Position is one of two in this area, which reports to the Treasury/Insurance function.
Duties
- Conduct thorough investigations of workers' compensation claims, gathering evidence and interviewing claimants and witnesses.
- Analyze claims to determine liability, extent of injuries, and other relevant factors.
- Evaluate medical records, injury reports, and other documentation to determine the validity of claims.
- Negotiate settlements with claimants, taking into account medical expenses, lost wages, and other related costs.
- Utilize financial software to calculate and manage claim payments.
- Identify and prevent fraudulent claims through thorough investigations and verification processes.
- Collaborate with internal departments, such as claims handling and medical services, to ensure a comprehensive approach to claim resolution.
- Provide exceptional customer service, ensuring that claimants are informed and satisfied with the resolution of their claims.
- Stay up-to-date with workers' compensation law and regulations, as well as industry best practices, to ensure compliance and optimal claim outcomes.
Qualifications
- Bachelor's degree in a related field, such as insurance, law, or business.
- Strong knowledge of workers' compensation law and regulations.
- Experience in claim adjusting, preferably in the workers' compensation industry.
- Proficiency in financial software, including auto estimating tools.
- Excellent analytical and problem-solving skills, with the ability to negotiate settlements and prevent fraudulent claims.
- Proven organizational and time management skills, with the ability to prioritize multiple claims and meet deadlines.
- Outstanding customer service skills, with a focus on delivering high-quality service to claimants.
- Ability to work independently and as part of a team.
- Commitment to continuous learning and professional development.
Job Type: Contract
Pay: $35.00 per hour
Expected hours: 40 per week
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work setting:
Experience:
- Workers' compensation: 5 years (Required)
- Workers' compensation law: 5 years (Required)
Ability to Commute:
- San Ramon, CA 94583 (Required)
Work Location: In person