Claims Adjuster

To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.


Job Title: Claims Adjuster - Workers Compensation

Duration: 4 Months

Location: Remote in CA


Must Skills:

  • Work location: Needs to be located in CA hopefully close to our Concord, CA office.
  • Need experienced examiner.
  • Sedgwick experience a plus
  • SIP certificate a plus
  • Needs good communication skills, customer services skills and quick responsiveness to the supervisor.
  • Must be able to keep diaries and mail current.


JOB DESCRIPTION:

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

  • Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
  • Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
  • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
  • Manages subrogation of claims and negotiates settlements.
  • Communicates claim action with claimant and client.
  • Ensures claim files are properly documented and claims coding is correct.
  • May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
  • Maintains professional client relationships.

 

QUALIFICATIONS

Bachelor's degree from an accredited college or university preferred.

 

Experience:

Four (4) years of claims management experience or equivalent combination of education and experience required.

 

Skills & Knowledge:

  • Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Analytical and interpretive skills
  • Strong organizational skill
  • Good interpersonal skills
  • Excellent negotiation skills
  • Ability to work in a team environment