Sr Workers Comp Examiner Job in Oakland, California US
Sr Workers Comp Examiner
At Kaiser Permanente Northern California, you'll join a team of health advocates who share your passion for helping people. From our financial professionals and IT team members to our RNs and physicians on the front line of care-we work together to help our members achieve their best level of wellness. And you'll be inspired to do the same. Whether you dream of sailing the bay, hitting the slopes in the Sierras, hiking Yosemite, attending the opera, or strolling the vineyards, you'll discover the cultural and recreational diversity that makes Northern California one of the most desirable places in the world to live and work. Northern California's largest health plan, Kaiser Permanente provides you with the resources, scope, and opportunity you need to realize your goals. Come see for yourself. This position manages complex litigated workers compensation indemnity claims requiring considerable judgment, independent analysis, detailed knowledge. In addition, acts in lead capacity in claims unit. Essential Functions: - Supervises administrative clerks claims assistant, including the distribution of work, coaching, performance evaluations - Acts as claims manager in the claims managers absence - Reviews approves work of examiners based on authority level - Trains claim examiners - Reviews, analyzes, assigns new claims - Assigns claims for investigation as necessary to help resolve compensability issues - Makes determination to accept, delay, or deny claims based upon valid medical, factual, or statutory reasons - Controls manages medical aspect of each claim - Determines probable monetary value of case assigns appropriate reserves - Reviews reserves regularly to ensure adequacy - Ensures payment of benefits in accordance w/ the California Labor Code, Administrative Rules Regulations, departmental policies procedures - Manages all aspects of litigated cases in accordance w/ client specifications - Assigns case to Rehabilitation Counselor as needed - Negotiates cost effective settlements - Meets w/ assigned clients at least quarterly to review claims discuss any pertinent issues - Assumes managerial responsibilities in absence of claims manager Secondary Functions: - Responsible for the daily management of workers compensation caseload of approximately 135 cases - Determines if a case should be accepted, delayed or denied based on medical, factual and legal aspects of each individual case - Controls and manages medical aspects of all cases in their caseload - Determines probable monetary value of each case and assigns a reserve amount - Ensures payment of benefits in accordance with the California Labor Code and department policies and procedures - Managers all aspects of litigation and negotiates settlements Requirements