Workers Compensation Claims Examiner III (Hybrid)
$85,000–$95,000 year
HybridSacramento, California, United States or Rancho Cordova, California, United States
Job Summary
Manage complex and litigated indemnity claims from inception to conclusion, initiating investigations, determining compensability, and administering benefits per state law and TRISTAR guidelines. Authorize medical treatment and billing, compute reserves, and settle claims while pursuing subrogation recovery. Communicate with claimants, attorneys, and providers to resolve issues and conduct file reviews. Mentor less experienced examiners and assist with state audit responses. This hybrid, temp-to-hire role reports to the Claims Supervisor and requires considerable interaction with vendors and medical providers.
Required Qualifications
- Minimum five (5) or more years of related experience
- Technical knowledge of statutory regulations
- Medical terminology
- Analytical skills
- Excellent written and verbal communication skills
- Ability to interact with persons at all levels in the business environment
- Ability to independently and effectively manage very complex claims
- Licenses as required by jurisdiction
- Reasoning development: Solve practical problems; variety of variables with limited standardization; interpret instructions
- Reasoning development: Logical or scientific thinking to solve problems; several abstract and concrete variables
- Mathematical development: Arithmetic calculations involving fractions, decimals, and percentages
- Mathematical development: Arithmetic, algebraic, and geometric calculations
- Language development: Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants
- Language development: Ability to compose original correspondence, follow technical manuals, and have increased contact with people
- Near vision: clarity of vision at 20 inches or less
- Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
- Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
- Color vision: ability to identify and distinguish colors
- Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
- Stooping: Bending body downward and forward by bending spine at the waist
- Kneeling: Bending legs at knee to come to a rest on knee or knees
- Crouching: Bending the body downward and forward by bending legs and spine
- Reaching: Extending hand(s) and arm(s) in any direction
- Standing: Particularly for sustained periods of time
- Walking: Moving about on foot to accomplish tasks, particularly for long distances
- Pushing: Using upper extremities to press against something with steady force in order to thrust forward, downward, or outward
- Pulling: Using upper extremities to exert force in order to drag, haul, or tug objects in a sustained motion
- Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position
- Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling
- Grasping: Applying pressure to an object with the fingers and palm
- Talking: Expressing or exchanging ideas by means of the spoken word
- Hearing: Perceiving the nature of sounds with or without correction
- Repetitive Substantial movements (motions) of the wrists, hands, and/or fingers
Desired Qualifications
- Proficient in Word and Excel
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