Workers Compensation Sr. Claims Examiner

Job Description

"We create happiness." That's our motto at Walt Disney Parks and Resorts. And it permeates everything we do. At Disney, you'll help inspire that magic by enabling our teams to push the limits of entertainment and create the never-before-seen!

Administers Workers' Compensation Benefits from claim incurral to resolution. Investigates, evaluates and analyzes claim issues and determines liabilitly on behalf of the Resort. Establishes case reserves and a time oriented plan of action for handling the claim. Administer benefits, manage disability, medical treatement and litigation issues as they arise.

Cases assigned may be more complex injuries involving disability management and medical management. Medical management of WC injuries working with the injured cast member, medical providers and nurse case managers as appropriate. Recognition of issues which may indicate adverse development of claim with addressing of those issues.

Complex analysis of wages per wate statement and calucation of indemnity benefits. Timely payment of indemnity, medical and allocated costs with emphasis on correctness, efficiency and compassion for the injured worker. Timely address of medical management issues and all required State of Califiornia Notices. Must address all issues of Return to Work within the guidelines set by the Resort.

Complete all work timely and completely in accordance with performance expectations. Litigation management and direction through the WCAB process. Communication with injured cast members, medical providers, attorneys, vendors and other partners as required. Case momentum must be maintained and staged for resolution and closure.

Employment Type

Full Time

Job Posting - Business

Disney Parks & Resorts

Additional Information

This position is a legal entity of Walt Disney Parks & Resorts, an equal opportunity employer.

Primary Job Posting Category

Legal

Basic Qualifications

• 5 years experience in management of occupational claims and administration of benefits
• Solid understanding of the State of California rules and regulations, the recent changes in the laws driven by recent reform including Utilization Review for medical care, Independent Medical Review and Independent Bill Review. Excellent communication skills (listening, verbal and written).
• Solid understanding of what it takes to be a proactive, inclusive team member.

Job Posting - Primary Brand

Disneyland Resort

Required Education

• High School Diploma or equivilent

Preferred Qualifications

• Self-Insurance Plans Administrator Certificate, 5 years minimum claims administration experience
• Bilingual

Primary Location-Postal Code

92802

Preferred Education

• Bachelor's Degree

Job Description

"We create happiness." That's our motto at Walt Disney Parks and Resorts. And it permeates everything we do. At Disney, you'll help inspire that magic by enabling our teams to push the limits of entertainment and create the never-before-seen!

Administers Workers' Compensation Benefits from claim incurral to resolution. Investigates, evaluates and analyzes claim issues and determines liabilitly on behalf of the Resort. Establishes case reserves and a time oriented plan of action for handling the claim. Administer benefits, manage disability, medical treatement and litigation issues as they arise.

Cases assigned may be more complex injuries involving disability management and medical management. Medical management of WC injuries working with the injured cast member, medical providers and nurse case managers as appropriate. Recognition of issues which may indicate adverse development of claim with addressing of those issues.

Complex analysis of wages per wate statement and calucation of indemnity benefits. Timely payment of indemnity, medical and allocated costs with emphasis on correctness, efficiency and compassion for the injured worker. Timely address of medical management issues and all required State of Califiornia Notices. Must address all issues of Return to Work within the guidelines set by the Resort.

Complete all work timely and completely in accordance with performance expectations. Litigation management and direction through the WCAB process. Communication with injured cast members, medical providers, attorneys, vendors and other partners as required. Case momentum must be maintained and staged for resolution and closure.

Employment Type

Full Time

Additional Information

This position is a legal entity of Walt Disney Parks & Resorts, an equal opportunity employer.

Basic Qualifications

• 5 years experience in management of occupational claims and administration of benefits
• Solid understanding of the State of California rules and regulations, the recent changes in the laws driven by recent reform including Utilization Review for medical care, Independent Medical Review and Independent Bill Review. Excellent communication skills (listening, verbal and written).
• Solid understanding of what it takes to be a proactive, inclusive team member.

Required Education

• High School Diploma or equivilent

Preferred Qualifications

• Self-Insurance Plans Administrator Certificate, 5 years minimum claims administration experience
• Bilingual

Preferred Education

• Bachelor's Degree

Responsibilities

• Communicate openly with all claim stakeholders (Cast Member, Medical Provider, Return to Work, Nurse Case Manager, Team Manager, Area/Line of Business).
• Review, analyze and determine specific plan of action on cases assigned to examiner
• Set case reserves as required by department guideline
• Administer WC benefits as required and in accordance with State of California rules and regulations
• Recognize and address all issues with case, advocate on behalf of the injured Cast Member
• Review, analyze and determine any Permanent Partial Disability benefits in accordance with State of California rules and regulations
• Manage all aspects of litigation utilizing resources provided by the department bringing case to resolution as indicated and required.