Workers Compensation Senior Claims Examiner

San Francisco, California
Jan 19, 2024
Feb 19, 2024
Full Time

National TPA is hiring a Sr. Claims Examiner to handle San Francisco claims. Bilingual Spanish preferred; the position is hourly at $87k-$95k/ year plus benefits. 

Establish contact with the employer to review issues • Respond to inquiries from the employer, employee, doctors and attorneys • Establish and maintain appropriate reserves • Review legal correspondence and medical reports • Evaluate and approve medical procedures and treatment • Administer benefits and ensure the appropriateness of all payments • Investigate coverage, liability and monetary value of claim • Review medical and legal bills for appropriateness • Discuss the appropriateness of medical treatment with medical case manager • Determine compensability • Monitor and assist litigation • Negotiate settlement of claim, liens, rehabilitation plans, etc • Prepare and present reports to clients Appropriately close claims • Help resolve client billing and payment inquiries • Investigate complaints from injured workers • Document and code the claim files and claims system with all relevant information • Maintain and update action plans within specified time frames • Provide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasks • Contact with employers, employees, attorneys, doctors, vendors and other parties • Provide customer service and support to clients and claimants • Work collaboratively with attorneys to draft settlements and assist with litigation strategies • Negotiate settlements • Authorize and negotiate cost of medical treatment and supplies • Internal communication with staff • Prepare professional, well written correspondence and other communications.