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Claims Examiner III


Fullerton, CA
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  • Accounting
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Job Details

Job Title: Claims Examiner III
Company: Safeway Inc
Country: U.S.
State/Province: California
City: Fullerton
Position Category: Finance & Accounting
Requisition Number: RSKM160107
Job Description: The Albertsons Companies are working to become the favorite food and drug retailer in every market it serves. The organization includes 2,230 stores, 27 distribution facilities and 19 manufacturing plants with over 250,000 employees across 34 states and the District of Columbia. The company is privately owned with supermarkets across the country that include: Albertsons, Safeway, Vons, Pavilions, Randall’s, Tom Thumb, Carrs, ACME, Jewel-Osco, Lucky, Shaw’s, Star Market, Super Saver, United Supermarkets, Market Street and Amigos.

The Workers’ Compensation Department, located in Fullerton, California, has an opening for a Claims Examiner III.

The Claims Examiner III is a senior examiner who manages the most complex workers compensation claims under minimal supervision. Intrinsic with the position is a high level of claims settlement authority. Using established company requirements, procedures, practices and policies, determine investigative strategy and most cost effective way to resolve the claim. The examiner's decision on conclusion of a claim is based upon an analysis of the facts, liability and applicable rules and laws. The senior claims examiner will be responsible for developing unique high level technical skills on specific unusual and costly claims issues. The senior examiner will act as the consultant on all such claims in the office. The senior examiner will act as a backup the Supervisor position.


• Perform three-point contact with Injured Worker, Facility Manager and Physician. Investigate (field or otherwise) all injuries, determine compensability of the claim, evaluate liability/exposure, identify and pursue subrogation and/or salvage and prepare proper reports as required. Evaluate and maintain timely claim reserves.
• Manage medical treatment, medical utilization, authorize, control and process bills within guidelines by using cost containment program; audit provider bills. Work with injured workers, facility managers and physicians to aid in the return to full or modified work duties.
• Manage the litigation process. Develop settlement and negotiate strategies with attorneys and injured workers, execute settlement documents and issue settlement benefits as approved by the WCAB or ADR mediators. Determine need for and direct defense counsel, independent examiners, or other experts and monitor and control their costs.
• Insure all WCAB and ADR filings are timely, handle WCAB/ADR administrative inquiries, and attend WCAB/ADR hearings.
• Communicate and interact with facility managers, injured workers, attorneys, physicians, vendors, Disability Evaluation Bureau, WCAB, etc., as needed. Interact with Division and Corporate Departments to obtain information necessary to resolve claims, discuss safety awareness and understand contractual issues presented to the company. Keep facility managers and appropriate risk management department personnel advised of file status.
• Prepare excess reporting as required. Insure accurate coding of data within the claims system. Identify and report all fraud. May represent the company at Boards Hearings or conferences.


Education Level:
• Four (4) year college degree or equivalent work experience
• S.I.P. certification required
• I.E.A. certificate required
• Advanced classes taken such as the IEA Labor Code and Case law, Advanced PD Rating or INS Supervisory classes or equivalent.

Experience Level:
• Minimum of six (6) to eight (8) years plus the education listed above.
• Minimum of five (5) years claims examiner experience.

Skills and Experiences:
• Knowledge of the States Workers' Compensation system principles, statutes and judicial protocol. (Benefit calculation, compensability decision time line factors, and subrosa).
• Knowledge of hearing and trial process and procedures.
• Knowledge of OSHA and state reporting requirements.
• Permanent disability systems and calculations Claims system coding and use.
• Excellent oral and written communication skills.
• Strong interpersonal, negotiation and customer service skills.
• Capable of dealing with demanding customers.
• Must be able to effectively work in a team environment.
• Computer literate and knowledge of computer claim applications and Microsoft Office Suite preferred.

Less than 15%.


The above statements are intended to describe the general nature and level of work being performed by employees assigned to this job classification. They are not intended to be construed as an exhaustive list of all responsibilities and skills required of personnel so classified.

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