Claims Examiner II, Workers' Compensation Job Listing at Safeway in Pleasanton, CA

Food & Beverage, Retail

The Northern California Division’s Workers’ Compensation Department, located in Pleasanton, California, has an opening for a Claims Examiner II.

Qualifications:
--4-year college degree or equivalent professional experience.
--3 years Claims Examiner experience with knowledge of Workers’ Compensation Statutes, medical terminology, medical treatment protocol, rating system, and litigation. Familiarity with AMA and ACOEM.
--State of California Self-Insurance Plans certification needed and I.E.A. preferred.
--Problem solving skills, analytical assessment, decision making, and negotiating skills.
--Computer and automated claims system experience.
--Excellent oral and written communication skills.
--Working knowledge of Microsoft applications.
--Able to work independently or with a group, handle multiple assignments, prioritize, organize, and meet deadlines.
--Good interpersonal skills with strong customer focus.

Key Responsibilities include, but are not limited to:

--Responsible for management and resolution of assigned caseload.
--Determine the exposure and best plan of action to bring the case to a conclusion.
--Apply case management skills designated to avoid and equitably resolve litigation.
--Forecast future liability as mandated by Self Insurance Plans.
--Provide authorization and direct activities of outside investigators and legal counsel.
--Daily data entry updates, maintenance of diary system, and monitor computer reports for accuracy.
--Authorize, control, and process medical treatment; audit provider bills. Monitor and administer cost containment programs.
--Utilize case required forms to specify history and plan the next course of action.
--Communicate and interact with injured workers, attorneys, physicians, vendors, Disability Evaluation Bureau, facility management, and Division Office personnel.
--Negotiate settlements with attorneys and injured workers, execute settlement documents, and issue settlement benefits as approved.
--Respond to various administrative inquires from the Division of Industrial Accidents.

Salary will be commensurate with experience and qualifications.