Full-Time Senior Claims Examiner, Workers’ Compesnsation
Job Description
We are looking for an experienced Senior Claims Examiner to join our Workers’ Compensation team! We are a fun, fast-paced team who work hard for our members. Are you organized, detailed-orientated, and can communicate effectively across all levels of the organization? Do you do well under pressure and changing priorities? Do you enjoy training and mentoring others? If you are interested in expanding your Workers’ Compensation career, our team is looking for you!
ABOUT BETA HEALTHCARE GROUP:
BETA Healthcare Group (BETA) is the largest professional liability insurer of hospitals on the west coast, providing coverage to more than 600 hospitals and healthcare facilities and provides workers’ compensation coverage for over 70,000 healthcare workers in California. BETA also has a long-established and growing commitment to physicians, providing medical professional liability coverage to nearly 7,000 physicians and more than 50 medical groups. Beyond liability and workers’ compensation coverage, BETA provides an entire suite of alternative risk and insurance services, including excess healthcare professional liability coverage, excess workers’ compensation coverage, third-party claims administration services, risk management consulting services and claims management consulting services. Whether with hospitals, medical groups, clinics or hospices, BETA has earned a reputation for financial strength, rate stability, quality service and breadth of coverage that is unparalleled in the industry. For the 2024-2025 renewal, we achieved 100% member retention.
ABOUT THE ROLE:
In this role you will manage a complex case load with exposures of greater severity including complex legal or medical issues; have a greater reserve and settlement authority, within client restrictions; and uses independent decision making in finding solutions critical for moving claims toward resolution, offering suggestion for improvement and implementing approved solutions. Claims files reflect a lower level of legal involvement and, when counsel is necessary, the Senior Claims Examiner takes on an active role in the litigation process, directing counsel (rather than passively accepting recommendations of counsel). This position is exempt, will allow telecommuting up to 3 days a week and must be located near the Granite Bay office.
IN THIS ROLE YOU WILL:
- Evaluate claim and determine course of action from inception to resolution timely and accurately
- Gather and analyze information including medical, legal, and factual evidence to determine compensability of claim
- Evaluate claim to determine appropriate use of independent medical evaluations for claims and/or refer to legal
- Evaluate all information to make appropriate independent determination on compensability and issue compensability decisions
- Manage and direct action of diary, e-mail, mail, faxes, phone calls, payments, required benefit notices, etc. to move claim to the best financial outcome and timely resolution
- Evaluate and establish medical, legal, vocational rehabilitation, and indemnity reserves based on facts of case and full potential exposure including reporting to excess carrier within authority level
- Evaluate and determine an appropriate negotiated settlement amount, within authority level
- Communicate, strategize and direct legal counsel regarding issues such as discovery, depositions, settlement value
- Provide superior claims processing and diary management as exhibited by appropriate reserves, timely payments, reports, contacts, closings and activity on the claim files
- Actively participate in the professional development of other team members by sharing knowledge and best practices through informal and formal training
- Represent the company as needed in depositions, conferences, hearings and trials
- All other duties as assigned or as situation dictates
ESSENTIAL JOB REQUIREMENTS
- High school diploma or G.E.D. required; Bachelor’s degree preferred
- Minimum five (5) years experience as a workers’ compensation examiner required
- Strong knowledge of claims management techniques, including investigation, reserving, cost analysis and case resolution techniques
- Strong customer focus with a strong sense of urgency and attention to detail
- Excellent organization skills and demonstrated experience managing multiple simultaneous projects
- Organizational and time management skills related to project management
- Proficient with Microsoft Office and be able to learn and implement specialty software systems and procedures
- Analyze a variety of information to maximize cost-effective claim management
- Discuss claim issues and justify claim reserves
- Anticipate problems and evaluate information to develop and evaluate options and implement solutions
- Communicate effectively, patiently and courteously with employees, Board Members, patrons and other community members and be responsible for protection of patron confidentiality
- Recognize insufficient reserve situations and bring to management’s attention timely
- Manage multiple activities or interruptions at once and to work positively and effectively within a team or
self-directed model
Certificate or other Licenses:
- SIP License required
- Maintain an active WCCA and WCCP Certificate or equivalent required
- Meet the ongoing training or experience requirements set forth in regulations California Code of Regulation (Article 20 of subchapter 3, chapter 5, Title 10) and (Section 2592.01[f])
Hiring base salary range: $95,000-105,000 annually depending on experience
- Note the amount listed is the base pay range; additional compensation may be available for this position.
How to Apply
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