Claims Examiner

  • Livingston, CA
  • Full-time

Company Description

Foster Farms has been a family-owned and operated company for four generations. Since our founding days back in 1939, we have always been committed to providing consumers with the highest-quality, best-tasting poultry products available. The hope is that our commitment to excellence, honesty, quality, service, and our people will shine through in everything we do.

We are always looking for talented individuals to join the Foster Farms team. We offer the experience of a large organization, but operate like a family business. More than half of our job openings are filled by internal promotion, and we encourage employees to gain a variety of experiences across different functional groups.

Job Description

Purpose of position:
Proactively manages all aspects of assigned caseload of workers’ compensation claims consisting of complex, high exposure, indemnity, litigated and future medical files. Responsible for the payment of benefits and ensuring medical treatment in compliance with State regulations and law. Responsible for assessing the financial exposure of assigned claims and maintaining appropriate reserves. Reports to Claim Supervisor.

Works closely with safety managers, human resource personnel, medical services, medical providers and attorneys to evaluate exposure and facilitate medical treatment, return to work programs, payment of workers’ compensation benefits and the resolution of workers’ compensation claims in compliance with company policies and state law. 


Essential Job Functions:
Responsible for proactive case management of assigned workers’ compensation claims files.

Determines financial exposure and sets case reserves on assigned cases, reevaluates and adjusts reserves within assigned authority according to changing circumstances and in accordance with departmental guidelines and state regulations. 

Notifies appropriate operations manager regarding reserve changes within authority limits.

Provides a reserve analysis and reports to supervisor for reserve changes over authority.

Maintains a proactive diary on each assigned claim file, creates plans of action to facilitate resolution of the claims. 

Responsible for medical case management and analysis. Authorizes appropriate medical treatment and payment in compliance with state regulations. 

Maintains compliance with Utilization Review, and MPN regulations. Uses services of

Utilization Review contractor, and case management nurses in accordance with departmental guidelines. 

Responsible for rating permanent disability according to State regulations. Responsible for benefit payments and state required notices in compliance with the Workers’ Compensation regulations, as concerns disability benefits, rehab issues, objections, etc. 

Negotiates settlements with injured workers and applicant attorneys within assigned authority and prepares settlement documents. 

Responsible for completion of Stipulations or C&R’s and obtaining employee signatures and approval of the Workers’ Compensation Appeals Board. Appearances at the Workers’ Comp Board as needed. 

Issues benefit payments and state required notices in compliance with the Workers’

Compensation regulations, as concerns disability benefits, rehab issues, objections, etc. 

Proactively directs and manages defense attorneys on litigated files.

Additional Functions:
Diaries files timely and appropriately, reviews and documents all mail in a timely manner and provides 90 day status reports on all files.

Conducts file reviews with plant management as required.

Other duties as assigned.

Qualifications

Requires thorough knowledge of California Workers’ Compensation Laws, regulations, case law and Medicare reporting with a minimum of 2 years case management experience.

Must qualify as an “experienced examiner” as defined by California Workers’ Compensation regulations.

Requires WCCA certification or equivalent training/experience.

Requires strong analytical skills, verbal and written communication skills and good interpersonal skills.

Requires strong case management skills.

Must be detailed oriented, well organized and dependable.

Must be able to work in fast paced environment and handle multiple tasks with professionalism, tact and composure.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Foster Farms is an Equal Opportunity Employer – Minorities, Females, Veterans and individuals with disabilities are encouraged to apply.

Foster Farms participates in E-Verify during the hire process at all locations for all new employees.