Lead Examiner, Workers' Compensation Claims

ADP is seeking a Lead Examiner for Workers' Compensation Claims to assist in monitoring and resolving issues within the workers compensation program. This role involves collaborating with internal and external business partners, reviewing claim files, and promoting early return to work programs. The ideal candidate will possess strong communication skills, attention to detail, and a comprehensive knowledge of workers compensation administration. This is a remote position within the state of California.

Responsibilities:

• Assist Claims Manager in monitoring the workers compensation program
• Identify and track trends to develop processes for improvement
• Review and provide concurrence to T.P.A. for reserves, settlements, and other items
• Consult and collaborate with internal and external business partners
• Monitor and ensure qualitative claim handling through T.P.A. and other vendor partners
• Resolve escalated complaints and concerns by clients and internal business partners
• Perform regular reviews of claims by specified criteria on diary
• Provide feedback and recommendations for resolution of claim files

Required Skills:

• Professional communication skills
• Ability to research complex issues and provide exceptional customer service
• Organizational skills and ability to work independently
• Understanding of workers compensation administration and related subjects
• Proficiency in Microsoft Office suite programs

Required Qualifications:

• 7-10 years of workers compensation claims experience in a client service environment
• Comprehensive knowledge of workers compensation administration
• Bachelor's degree or equivalent experience

Preferred Qualifications:

• Comprehensive knowledge of general insurance policy coverage and state case laws
• Experience in a PEO environment
• Familiarity with Risktrac and Origami
• Location in Southern California preferred