Associate Claims Examiner

Company Details

 

Preferred Employers Insurance, A Berkley Company specializes in providing workers’ compensation insurance to California business owners. The company serves three major Product/Client Segments: Small Business, Mid-Larger Businesses and Group Association Members (Programs). The company’s distribution partners (agents & brokers) number just under 400 locations throughout the state. Preferred serves thousands of policyholders and provides medical claims handling and claims management as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company.

 

Company URL:      https://www.peiwc.com

 

The company is an equal opportunity employer.

Responsibilities

The Associate Claims Examiner (ACE) utilizes general understanding of department’s operation and objectives.  They are responsible for entering claim indemnity payments, SROI filing, issue Benefit Notices, complete void/stop payment, and reissuing of checks with a 99% timeliness goal. The ACE position will provide customer service to the claims department, and assist Claims Technical and Operations with other duties as needed and as time allows. This position will make inquiries with claims examiners, medical providers and injured workers, as needed, to assess return to work status and determine whether further payments should be issued. This position acts in a fiduciary role on behalf of insureds in assessing the need for indemnity payments. Job functions are considered routine and predefined and require minimum evaluation. The ACE administers the payment of benefits with the utmost, good faith, in compliance with the rules, regulations and statutes of the State of California and the WCAB. The ACE must be a team player.

 

This position requires particular attention to detail, and is often task-oriented. This position will require 120 hours of classroom training at Supervisor’s direction within the first year in position in order to obtain Experienced Examiner Certification. 30 hours of continuing education every two years is required to maintain that certification.

 Key responsibilities include but are not limited to:

• Make indemnity payments to claimants, both lump sum and ongoing payments, including initial, final and retroactive periods.
• Issue Benefit Notices as required with regards to the start, changing and ending of benefits.
• Will issue Permanent Disability denials in certain circumstances and notify claims examiner with an Activity.
• Transmit Second Report of Information (SROI) to the State of California as required.
• Gather and document information from medical providers on disability status of claimants.
• Referral to Return to Work Coordinator who will gather and document information from insureds on return to work status of their injured employees as well as availability of modified or alternate duties. Follow up on return to work status, through coordinator, until an offer is made or a final decision not to accommodate is made.
• Refers cases as appropriate to management by setting an activity for review.
• Maintains professional client relationships.
• Timely and appropriate notification to examiner on cases with indemnity payments, on need for appropriate reserves to ensure adequacy for life of claim.
• Coordinate and process void, stop pay, and reissue Indemnity payments.
• Offer and, if accepted, enroll claimants in our EFT program.
• Attend Examiner Certification training as directed by Supervisor.
• Upon certification as an Experienced Examiner, additional duties may be added including, but not limited to, drafting of settlement documents and calculation of wage statements.
• Assist technical and operations with other duties as needed and as time allows.

Qualifications

• Bachelor degree from an accredited college or university preferred
• 2+ years of related administrative office work experience.
• Strong written and verbal communication skills, attention to detail and deadline structures.
• Ability to work both independently and collaboratively with all levels of staff.
• Proficient with MS Office software and PC applications and systems.
• Baccalaureate degree from an accredited college or university preferred
• Knowledge of workers’ compensation principles and policies equivalent preferred.

Additional Company Details

We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $60,000 – $80,000 annually • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Sponsorship Details

Sponsorship not Offered for this Role

Responsibilities

The Associate Claims Examiner (ACE) utilizes general understanding of department’s operation and objectives.  They are responsible for entering claim indemnity payments, SROI filing, issue Benefit Notices, complete void/stop payment, and reissuing of checks with a 99% timeliness goal. The ACE position will provide customer service to the claims department, and assist Claims Technical and Operations with other duties as needed and as time allows. This position will make inquiries with claims examiners, medical providers and injured workers, as needed, to assess return to work status and determine whether further payments should be issued. This position acts in a fiduciary role on behalf of insureds in assessing the need for indemnity payments. Job functions are considered routine and predefined and require minimum evaluation. The ACE administers the payment of benefits with the utmost, good faith, in compliance with the rules, regulations and statutes of the State of California and the WCAB. The ACE must be a team player.
 
This position requires particular attention to detail, and is often task-oriented. This position will require 120 hours of classroom training at Supervisor’s direction within the first year in position in order to obtain Experienced Examiner Certification. 30 hours of continuing education every two years is required to maintain that certification.
 Key responsibilities include but are not limited to:
- Make indemnity payments to claimants, both lump sum and ongoing payments, including initial, final and retroactive periods.
- Issue Benefit Notices as required with regards to the start, changing and ending of benefits.
- Will issue Permanent Disability denials in certain circumstances and notify claims examiner with an Activity.
- Transmit Second Report of Information (SROI) to the State of California as required.
- Gather and document information from medical providers on disability status of claimants.
- Referral to Return to Work Coordinator who will gather and document information from insureds on return to work status of their injured employees as well as availability of modified or alternate duties. Follow up on return to work status, through coordinator, until an offer is made or a final decision not to accommodate is made.
- Refers cases as appropriate to management by setting an activity for review.
- Maintains professional client relationships.
- Timely and appropriate notification to examiner on cases with indemnity payments, on need for appropriate reserves to ensure adequacy for life of claim.
- Coordinate and process void, stop pay, and reissue Indemnity payments.
- Offer and, if accepted, enroll claimants in our EFT program.
- Attend Examiner Certification training as directed by Supervisor.
- Upon certification as an Experienced Examiner, additional duties may be added including, but not limited to, drafting of settlement documents and calculation of wage statements.
- Assist technical and operations with other duties as needed and as time allows.