We are looking for a meticulous Workers Compensation Claims Examiner to join our team in Roseville, California. You will be handling and overseeing workers' compensation claims from start to finish, ensuring compliance with legal standards and our internal policies. Your role will require excellent communication skills, problem-solving abilities, and a comprehensive understanding of workers' compensation regulations.

Responsibilities:

• Analyze and process workers' compensation claims in a timely and efficient manner.

• Review medical records, accident reports, and other documentation to establish the validity of claims.

• Keep track of ongoing claims to ensure proper case management and resolution.

• Confirm that claims comply with regulatory guidelines and state-specific workers' compensation laws.

• Document claims, correspondence, and actions taken in detail.

• Communicate effectively with claimants, medical professionals, attorneys, and other stakeholders about claim status.

• Clearly explain workers’ compensation policies and procedures.

• Professionally address questions and concerns, ensuring a positive experience for all parties involved.

• Evaluate claim situations and make decisions about approvals, denials, settlements, or escalations based on evidence and policy.

• Negotiate settlements and authorize payments within set limits.

• Identify potential fraud or discrepancies within claims and report irregularities to the correct departments.

• Evaluate risks and recommend strategies for minimizing cases of non-compliance or overpayment.

• Collaborate with internal teams, including HR, legal, and finance departments.

• Keep up to date with changes in workers' compensation laws and guidelines.

• Participate in training programs to enhance claims management skills.