We are recruiting for a Senior Claims Examiner to join a professional services organization in Granite Bay. This is a long term contract opportunity to work with a company renowned for delivering high-quality service in the healthcare industry. The Senior Claims Examiner is responsible for managing a complex case load of workers’ compensation claims. This position is onsite, M-F, 37.50 hours/week. Pay: $42-$50/hour DOE. 

The qualified candidate will have at least five years of experience as a workers’ compensation examiner, excellent technical knowledge of worker’s compensation law, strong analytical skills, and an active SIP license. 

PRIMARY RESPONSIBILITIES:

• Interpret and make decisions using independent judgment on more complex and unusual policy coverages and determine if coverages apply to claims submitted.
• Manage all aspects of investigative activity on complex claims. Evaluate claim to determine appropriate use of independent medical evaluations for claims and/or refer to legal. Direct the discovery and litigation strategy with legal counsel.
• Gather and analyze information including medical, legal, and factual evidence to determine compensability of claim.
• Analyze claims activity and prepare reports for clients/carriers and management.
• Evaluate all information to make appropriate independent determination on compensability and issue compensability decisions.
• Establish reserves, using independent judgment and expertise and authorize payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.
• Settle claims promptly and equitably and issues company drafts in payments for claims within authority limits.
• Represent the company as needed in depositions, conferences, hearings, and trial.
• Perform other duties as assigned. 

SKILLS & QUALIFICATIONS:

• High school diploma or G.E.D. required; Bachelor’s degree preferred. 
• SIP license required. 
• Five years’ experience with technical claims investigations/settling experience required.
• Exceptional knowledge of claims management techniques, including investigation, reserving, cost analysis and case resolution techniques. 
• Strong customer service with a sense of urgency and attention to detail. 
• Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects.
• Proficient with Microsoft Office and be able to learn and implement specialty software systems and procedures. 
• Ability to discuss claim issues and justify claim reserves.
• Excellent written and verbal communication and negotiation skills.