Triage Claims Examiner

San Diego, California

 

PURPOSE OF THE JOB

The purpose of this job is to administer benefits to injured workers in accordance with statutory and case law as well as pertinent regulations. This job reserves and assesses Workers Compensation claims within the Company standards and best practices guidelines.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Administers benefits to injured workers

  • Creates reserves in a timely manner to ensure reserving activities consistent with company policies.
  • Communicates with insureds to obtain information necessary for processing claims.
  • Contacts and/or interviews claimants, doctors, medical specialists, or employers to get additional information.
  • Manages and approve payment of benefits within designated authority level.
  • Assesses claims fairly and equitably, acting in the best interest of the insured and providing benefits as prescribed by law.

EDUCATION AND EXPERIENCE

High school diploma or general education degree (GED). Bachelors degree from four-year college or university preferred.

Must receive certification that meets the minimum standards of training, experience, skill and further education. Basic understanding of laws and jurisdictional restraints to manage injuries.

CERTIFICATES, LICENSES, REGISTRATIONS

WCCA and WCCP not required but helpful. State Workers Compensation License required in some branches.

KNOWLEDGE AND SKILLS

Excellent verbal and written communication skills, time management and organizational skills. Requires a high level of attention to detail. Team oriented and a sense of urgency for execution.

COMPETENCIES

This position maps to the Individual Contributor competency level. Additional competencies required: Problem Solving and Decision Making

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