Senior Claims Examiner

  • Full-time
  • PL-DEPT: 01-0610

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

  1. 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. 
  2. Notifies appropriate operations manager regarding reserve changes of $20,000 - $30,000. Provides a reserve analysis and reports to claim manager for reserve changes over authority. 
  3. Maintains a proactive diary each assigned claim file, creates plans of action to facilitate resolution of the claims.
  4. Responsible for medical case management and analysis. Authorizes appropriate medical treatment and payment in compliance with state regulations.
  5. Maintains compliance with Utilization Review, and MPN regulations. Uses services of Utilization Review contractor, and case management nurses in accordance with departmental guidelines. 
  6. Responsible for rating permanent disability according to State regulations. 
  7. Responsible for benefit payments and state required notices in compliance with the Workers’ Compensation regulations, as concerns disability benefits, rehab issues, objections, etc. 
  8. Negotiates settlements with injured workers and applicant attorneys within assigned authority and prepares settlement documents. 
  9. 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. 
  10. Proactively directs and manages defense attorneys on litigated files. 
  11. Supervision and training of claims compliance assistant and clerical support

Additional Responsibilities:

  1. Diaries filed timely and appropriately
  2. Reviews and documents all mail, in a timely manner
  3. Conducts file reviews with plant management, as required
  4. Other duties as assigned


Qualifications

  1. Administrators Certificate from Office of Self-Insurance Plans.
  2. Must possess a current Experienced Claims Adjuster Designation, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f).
  3. Requires solid knowledge of California Workers’ Compensation Laws, policies and procedures.
  4. Proficiency in determining case value.
  5. Requires understanding of medical and legal terminology.
  6. Strong verbal and written communication skills.
  7. Ability to work in a paperless environment.
  8. Ability to prioritize multiple tasks and meet deadlines.

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.

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