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.
Responsibilities
- Evaluate claims and determine course of action from inception to resolution timely and accurately
- Gather and analyze information including medical, legal, and factual evidence to determine compensability of claim
- Evaluate claims to determine appropriate use of independent medical evaluations for claims and/or refer to legal
- Evaluate all information to make appropriate determination on compensability and issue compensability decisions
- Manage 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 resolution
- Evaluate and establish medical, legal, vocational rehabilitation, and indemnity reserves based on facts of case and probable exposure, including reporting to excess carrier, within authority level
- Evaluate and determine an appropriate negotiated settlement amount, within authority level
- Communicate, strategize and direct legal counsel regarding issues such as discovery, depositions, settlement value
- Provide superior claims processing and diary management as exhibited by appropriate reserves, timely payments, reports, contacts, closings and activity on the claim files
- Represent the company as needed in depositions, conferences, hearings and trials
- Travel may be required periodically, which may include overnight stays and/or transportation via airplane
- All other duties as assigned or as situation dictates
Skills
- High school diploma or G.E.D. required; Bachelor's degree preferred
- Minimum one (1) years' experience as a workers' compensation examiner or equivalent
- Knowledge of claims management techniques, including investigation, reserving, cost analysis, and case resolution techniques
- Strong customer focus with a strong sense of urgency and attention to detail
- Excellent organizational skills
- Manage multiple simultaneous projects; working independently in a multi-tasking office setting
- Proficient with Microsoft Office and be able to learn and utilize specialty software systems and procedures
- Must have excellent verbal and written communication skills including the ability to proofread the work of self and others with a high degree of accuracy
- SIP license required or achieved within 6 months of promotion or hire
- Meet 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 Overview
- BETA 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.