We are looking for a new Claims Examiner to add to our Workers’ Compensation team! We are a fun, fast-paced team who work hard for our members. Are you driven by the ability to set and exceed results-orientated goals? Are you organized, detail-orientated, and can communicate effectively? Do you do well under pressure or changing priorities? If you are interested in building your career in Workers' Compensation Claims Management, our team is looking for you!

ABOUT BETA HEALTHCARE GROUP:

BETA Healthcare Group (BETA) is the largest professional liability insurer of hospitals on the west coast, providing coverage to more than 600 hospitals and healthcare facilities and provides workers' compensation coverage for over 70,000 healthcare workers in California. BETA also has a long-established and growing commitment to physicians, providing medical professional liability coverage to nearly 6,000 physicians and more than 50 medical groups. Beyond primary liability and workers’ compensation coverage, BETA provides an entire suite of alternative risk and insurance services, including excess healthcare professional liability coverage, excess workers’ compensation coverage, third-party claims administration services, risk management consulting services and claims management consulting services. Whether with hospitals, medical groups, clinics or hospices, BETA has earned a reputation for financial strength, rate stability, quality service and breadth of coverage that is unparalleled in the industry. For 2024-2025 renewal, we achieved 100% member retention.

ABOUT THE ROLE:

In this role, you will support two Claims Assistants and will manage all aspects of claims to include gathering information necessary to make informed and responsible decisions to bring claims to appropriate resolution. Under general supervision, develop and carry out a plan of action for claim resolution consistent with statutory requirements and client specifications. Establish reserves and work in concert with employers, employees, medical providers, attorneys and other vendors to maximize cost-effective claim management. This position allows telecommuting up to 3 days a week after a training period. This is an exempt position and located in our Granite Bay, CA office.

IN THIS ROLE YOU WILL:

Evaluate claim 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 claim 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
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 organization 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
SIP license required
WCCA Certificate or equivalent preferred
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])
· Note the amount listed is the base pay range; additional compensation may be available for this position.

ESSENTIAL JOB REQUIREMENTS

Certificate or other Licenses:

Hiring base salary range: Up to $74,000-81,000 annually depending on experience

For morning information on BETA, view benefit offerings, mission, vision, values, and complete your application www.betahg.com/careers

Please no recruiting firm solicitation.

BETA Healthcare Group

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Claims Examiner, Workers' Compensation