Workers' Comp Claim Representative III - CA

Job description

SUMMARY: This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May handle large, more complex customers requiring high touch, labor intensive claim service. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Mentors lower-level claim handlers. Coordinates special projects and provides guidance to others. Candidate must have California experience. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. - Verifies workers’ compensation coverage of employers and injured employees. - Determines compensability under workers’ compensation by thorough investigation of the claim. - Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. - Facilitates return to work for the injured employee. - Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. - Documents specifics of claims with potential for subrogation recovery, including amount...