Workers' Compensation Claims Examiner Trainee - Walnut Creek, CA
- Career Level
- Entry Level
The Claims Examiner Trainee, is the first working professional level of claims handling. Under close supervision, the Claims Examiner Trainee will receive in depth training of department objectives, and workers’ compensation laws to be able to administer basic claim benefits. The training will consist of learning to handle simple medical only claims to handling complex medical only claims, involving non-litigated, minimal lost time, soft tissue type injuries. Other items handled include strain/sprain injuries due to repetitive motion and minor indemnity disability claims. The Claims Examiner Trainee will ultimately be able to determine compensability and handle uncomplicated claims issues on assigned claims. Claims handling activities will be performed in compliance with the rules, regulations and statutes of the WCAB and the State of California.
- Provide customer service – answer telephones by the third ring and re-direct callers as necessary to properly respond to customer inquiries.
- Complete three-point contact to properly investigate assigned claims, evaluate coverage and determine compensability.
- Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim.
- Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
- Negotiate outstanding liens on settled claims.
- Complete assigned work via diaries and work queues in a timely manner.
- Appropriately initiate QME and Voucher process for unrepresented claims.
- Perform other duties as requested by manager.
- Strong written and verbal communication skills
- Strong organizational skills
- Strong negotiation skills
- Strong analytical and interpretive skills
- PC literate
- Baccalaureate degree from an accredited college or university preferred
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