Claims Examiner, Workers Compensation

BETA Healthcare Group is the largest professional liability insurer of hospitals on the west coast, providing coverage to over 600 hospitals and healthcare facilities. They are seeking a Claims Examiner to manage all aspects of claims in the Workers' Compensation team, ensuring timely and accurate resolutions while collaborating with various stakeholders.ResponsibilitiesEvaluate claims and determine course of action from inception to resolution timely and accuratelyGather and analyze information including medical, legal, and factual evidence to determine compensability of claimEvaluate claims to determine appropriate use of independent medical evaluations for claims and/or refer to legalEvaluate all information to make appropriate determination on compensability and issue compensability decisionsManage 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 resolutionEvaluate and establish medical, legal, vocational rehabilitation, and indemnity reserves based on facts of case and probable exposure, including reporting to excess carrier, within authority levelEvaluate and determine an appropriate negotiated settlement amount, within authority levelCommunicate, strategize and direct legal counsel regarding issues such as discovery, depositions, settlement valueProvide superior claims processing and diary management as exhibited by appropriate reserves, timely payments, reports, contacts, closings and activity on the claim filesRepresent the company as needed in depositions, conferences, hearings and trialsTravel may be required periodically, which may include overnight stays and/or transportation via airplaneAll other duties as assigned or as situation dictatesSkillsHigh school diploma or G.E.D. required; Bachelor's degree preferredMinimum one (1) years' experience as a workers' compensation examiner or equivalentKnowledge of claims management techniques, including investigation, reserving, cost analysis, and case resolution techniquesStrong customer focus with a strong sense of urgency and attention to detailExcellent organizational skillsManage multiple simultaneous projects; working independently in a multi-tasking office settingProficient with Microsoft Office and be able to learn and utilize specialty software systems and proceduresMust have excellent verbal and written communication skills including the ability to proofread the work of self and others with a high degree of accuracySIP license required or achieved within 6 months of promotion or hireMeet 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])Company OverviewBETA Healthcare Group is a provider of insurance solutions for the healthcare industry. It was founded in 1979, and is headquartered in Alamo, California, USA, with a workforce of 51-200 employees. Its website is https://betahg.com.



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