Workers' Compensation Claims Specialist

Date Posted: 7/22/2020

Employer: PRISM - Public Risk Innovation, Solutions, and Management

Salary Range: $4,894.00 -$5,873.00

Contact: Allison Bateman

Phone: 916-850-7300

Website: Open Until Filled

JOB APPLICATION

About The Position

The Workers’ Compensation Claims Specialist, under the general direction of the Workers’ Compensation Supervising Senior, will:
• Maintain a caseload of future medical excess workers’ compensation claims;
• Monitor reserves and case statuses to ensure compliance with Addendum A Standards;
• Input claims reserves into financial database;
• Report cases with potential above PRISM coverage to requisite carriers;
• Reconcile claims for reimbursement, and present to Claims Review Committee for approval;
• Update information concerning claims activity and maintain claims files;
• Prepare correspondence;
• Generate requisite reports from claims files;
• Contact member agencies or TPAs concerning claims status and information;
• Identify files for closure and do related work as required;
• Attend file reviews with the member and TPA when indicated;
• Provide training to the members and TPAs when indicated.

Job Requirements

The ideal candidate will have an Associates’ Degree and two years of increasingly responsible work experience in insurance claims adjusting, reporting, management and settlement work; or, an equivalent combination of education and experience sufficient to successfully perform the essential functions of the job.
Skills include:
• Strong working knowledge in Microsoft Office including Word and Excel
• Experience working with a RMIS system (SIMS, Valley Oaks, David Systems, ATS, etc.)
• Basic knowledge of recordkeeping principles
• Ability to set priorities and handle multiple projects simultaneously
• Ability to handle basic arithmetical calculations
• Ability to establish and maintain effective working relationships and good public relations with other employees, agencies, members, and the public
• Completion of specialized educational training and courses related to insurance claims adjusting, reporting, settlement, and management are highly desirable
• Public agency claims experience is highly desirable
• SIP Certificate
• Ability to maintain a current workload (diary, mail, settlement authorizations, etc.)
• Ability to travel when indicated

Benefits

A generous benefit package is provided including Public Employees Retirement System (PERS); a Section 125 Cafeteria Plan with a generous allowance from which coverage may be provided for the employee and their dependents for health, dental, and vision insurances; long-term disability and short-term disability insurance; life insurance; deferred compensation program; 13 paid holidays per year, and sick, vacation and management leaves. As a PERS participant, PRISM employees are exempt from paying into Social Security, except for the Medicare portion of the cost.

Physical Requirements

Physical requirements of this position typically include: sitting for long periods of time, reaching, grasping, kneeling, talking, hearing, seeing, repetitive motions, exerting up to 20 pounds of force occasionally and/or up to 10 pounds of force frequently, and/or negligible amount of force constantly to move.

Special Requirements

Possession of a valid State of California Driver’s License issued by the State Department of Motor Vehicles, or the ability to obtain one within the first month of employment. Proof of auto insurance with no exclusion for business use is required.