DaVita Claims Examiner - Worker's Compensation in El Segundo, California
GENERAL PURPOSE OF THE JOB
This position manages the Company’s Workers’ Compensation claims and acts as a direct liaison between management staff, teammates, insurers, claim adjusters, and defense counsel. The position directs claims resolution activities including claim reserve analysis and claim settlements.
SUPERVISORY RESPONSIBILITIES: No
ESSENTIAL DUTIES AND RESPONSIBILITIES:
The following duties and responsibilities generally reflect the expectations of this position but are not intended to be all inclusive.
• Evaluate claims to determine potential exposure; make recommendations concerning the value of the claim; oversee litigation and assist in the negotiation of settlements.
• Proactively oversee the Worker’s Compensation claims management activities in assigned territories with a special focus on cost containment strategies.
• Manage and target aggressive resolution of case inventory, and resolve problems of varying scope and complexity in accordance with state statutes.
• Evaluate claims for settlement and appropriateness of established reserves.
• Attend claim reviews; complete follow up action to ensure expedited resolution.
• Provide daily support / guidance to teammates, claims adjusters, insurers, and defense counsel by answering claims-related questions or concerns in the administration and management of claims, return-to-work issues, and other claim matters.
• Analyze claims data to identify needed loss control interventions and assist with the development of appropriate loss prevention programs as requested.
• Provide training and education to facilities on claim processes and procedures.
• Coordinate handling of claim subpoenas in an expeditious manner.
• Generate reporting and analysis on assigned case inventory.
• Escalate exceptions, outliers, or circumstances that are out-of-norm, as they occur, and seek guidance in case resolution.
• Participate in meetings, presentations, and special projects, as necessary.
• Other duties and responsibilities as assigned including but not limited to:
o Attend Company meetings, phone conferences, and training sessions
o Know, understand, and follow teammate guidelines, employment policies, and department or company procedures
o Flexible schedule and ability to travel required
• Travel up to 15% as needed
Here is what you can expect when you join our Village:
- A "community first, company second" culture based on Core Values that really matter.
- Clinical outcomes consistently ranked above the national average.
- Award-winning education and training across multiple career paths to help you reach your potential.
- Performance-based rewards based on stellar individual and team contributions.
- A comprehensive benefits package designed to enhance your health, your financial well-being and your future.
Dedication, above all, to caring for patients suffering from chronic kidney failure across the nation.
(Education, licenses, certifications, and experience required to fulfill the essential duties, include computer skills as required)
• Bachelor’s degree in related area required.
• Workers’ Compensation certification preferred, e.g. WCCP, WCCA, etc.
• Minimum of three years’ experience handling Workers’ Compensation claims is required.
• Intermediate computer skills and proficiency in MS Excel, Outlook, Word, PowerPoint, and web based claim data systems is required.
ESSENTIAL BEHAVIORS, SKILLS, AND ATTITUDES REQUIRED FOR SUCCESS IN THIS POSITION
• Commitment to Company’s values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment and Fun with ability to demonstrate those positively and proactively to patients, teammates, management, physicians, and/or vendors in every day performance and interactions.
• Demonstrated sound judgment and initiative in working within departmental and corporate guidelines, including the ability to maintain confidentiality of information.
• Strong written, verbal, and interpersonal communications skills including ability to listen attentively and to communicate information clearly and effectively throughout all levels of the organization with audiences of varying degrees of familiarity with material
o Demonstrated ability to work well with cross-functional groups
o Demonstrated interpersonal, collaborative, and relationship-building skills; ability to interact positively with teammates at various levels across the company
o Approachable and open
o Demonstrated ability to communicate difficult or sensitive information tactfully
• Self-directed; able to function independently and as a member of a team and to foster a positive work environment.
• Demonstrated strengths in organizational, attention-to-detail, follow-through, critical thinking, and innovative problem solving skills.
• Strong time management skills; ability to manage multiple projects, deadlines and multiple priorities in a fast-paced, ever changing and evolving work environment with shifting time frames.
• Strong understanding of business process with the ability to deliver requested output timely and accurately.
• Strong analytical skills with the ability to seek out underlying assumptions through probing, questioning, and listening; ability to analyze information quickly and accurately with demonstrated ability to perform root cause analysis, prepare and implement action plans, and lead improvement initiatives.
Join us as we pursue our vision " To Build the Greatest Healthcare Community the World has Ever Seen . "
Why wait? Explore a career with DaVita today.
Go to http://careers.davita.com to learn more or apply.
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The DaVita Village is committed to being an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability or protected veteran status.
We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.