Senior Claims Examiner, Workers' Compensation - San Jose California

Company: to Accretive Insurance Solutions
Location: San Jose, California
Posted On: 05/08/2025

OverviewAdminister indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation.Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability.What You'll Do

• Maintain current diary.
• Identify, prevent and mitigate potential penalties.
• Update claim notes in computer.
• Provide timely reporting of excess files to the Reinsurance Manager.
• Report SIU/Fraud.
• Identify and pursue subrogation.
• Complete Rehab forms/benefit notices/SJDB/RTW form.
• Refer all PRIME deletions only to office designee.
• Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim.
• Prepare for and attend file reviews.
• Accept or deny delayed claims within 90 days.
• Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date.
• Complete Stipulation and/or Compromise and Release paperwork.
• Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually.
• Prepare legal referrals, provide direction to and monitor defense attorney.
• Return all phone calls within 24 hours.
• Complete instruction sheets for Assistant/Technician/Claims entry clerk.
• Review mail daily.
• Correct error report daily.
• Maintain client/claimant satisfaction.
• Update Unit Stat forms.
• Oversee new set-ups, reserves and instruction sheets.
• Prepare cover letters to AME/defense QME, AOE/COE evaluations.
• Negotiate outstanding liens.
• Make 3-point contact.
• File Answer/Application.
• Interaction with nurse on case management.
• Other duties assigned.What You'll Need
  • Minimum of five (5) years of California Workers' Compensation Claims Examiner experience and a Self-Insurance Certificate, or the ability to pass Self-Insurance Test within one (1) year of hire. WCCP preferred.
  • Two (2) years of experience in handling public entity claims is preferred.
  • Effective in verbal and written communication.
  • Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required.What's in it For You?To help you make the best decision for your personal growth, it's important to us to share a glimpse of what we offer our top asset, our people:
    • Competitive base salary.
    • Generous 30+ Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days.
    • Health benefit options with you in mind; 5 affordable medical plan options with rates based on your salary, company paid HSA contribution with eligible HSA plan selection, 2 dental plan options offering orthodontia coverage and 3 cleanings per year, and 2 vision plan options.
    • Company match 401(k) plan - 50% up to 6%!
    • Support of your fitness wellness goals! We offer up to 75% off at over 11,000 gyms and fitness centers.
    • Opportunity to prioritize your mental health with 24/7 access to licensed therapists.
    • Pet benefits & discounts.
    • Access to our Employee-led Resource Groups (ERGs) that lend a voice to the variety of demographics represented throughout our company.Compensation:The target salary range for this position is $75,000.00 to $105,000.00 (US Dollar) annually. The actual salary will vary based on applicant's education, experience, skills, and abilities, as well as internal equity and alignment with market data. The salary may also be adjusted based on applicant's geographic location. Remote work environment flexibility but candidate must have California workers' compensation claims experience.Grow, with usAccretiveis a collection of elite specialty and wholesale agencies supported by experienced industry leaders. Our expertise is broad, and our innovative culture runs deep. We value relationships above all else and consistently deliver best in class customized solutions and service you can trust.Accretiveis passionate about fueling our clients' innovation and growth. That makes us the perfect place for creative, dynamic people who want to grow their career while helping businesses, families and people thrive.We are proud to be one of the largest brokers in the country,but we're even prouder of the honest, caring relationships that our employees build with our clients every day.Working with us will give you the opportunity to do work that matters while you learn with us, advance with us, and most importantly, grow with us. Accretive is committed to embracing diversity, equity and inclusion to create a workplace that welcomes and thrives on the unique experiences, perspectives and contributions of all team members. Accretive is bringing the best people and most diverse talent forward to drive growth, innovate and think bigger!
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