Claims Adjuster - Workers Compensation

TAJ Technologies Inc; Long Beach (CA); On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a skilled Claims Manager to oversee workers compensation claims. In this pivotal role, you will analyze mid- and higher-level claims, ensuring compliance with company standards and industry best practices. Your expertise will facilitate the negotiation of settlements and the management of action plans, all while maintaining strong relationships with clients. This is a fantastic opportunity to contribute to a quality-driven organization that values your insights and fosters professional growth. If you have a passion for claims management and a commitment to excellence, this role is tailored for you.

Qualifications

• 5+ years of claims handling experience is mandatory.
• Bachelor's degree preferred, with strong analytical and communication skills.

Responsibilities

• Manage workers compensation claims and determine benefits due.
• Negotiate settlements and maintain professional client relationships.
• Ensure claims are documented and coded correctly.

Skills

Claims Management

Communication Skills

Analytical Skills

Organizational Skills

Interpersonal Skills

PC Literacy

Teamwork

Education

Bachelor's Degree

Tools

Microsoft Office

Job description

Min 5 years of CA claims handling experience is mandatory.

SIP is preferred.

PRIMARY PURPOSE :

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.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

1. Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
2. Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
3. Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
4. Manages subrogation of claims and negotiates settlements.
5. Communicates claim action with claimant and client.
6. Ensures claim files are properly documented and claims coding is correct.
7. 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.
8. Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

1. Performs other duties as assigned.
2. Supports the organization's quality program(s).
3. Travels as required.

QUALIFICATIONS

Education & Licensing

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

1. 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.
2. Excellent oral and written communication, including presentation skills.
3. PC literate, including Microsoft Office products.
4. Analytical and interpretive skills.
5. Strong organizational skill.
6. Good interpersonal skills.
7. Ability to work in a team environment.
8. Ability to meet or exceed Service Expectations.