Claims Adjuster - Workers Compensation (Hourly)

ObjectWin Technology; Sacramento (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading technology firm is seeking a Claims Adjuster for Workers Compensation, focusing on analyzing and managing claims to ensure proper adjudication within industry standards. The successful candidate will have a bachelor's degree, significant experience, and strong negotiation and analytical skills. This remote position requires someone familiar with California's regulations and able to manage claims effectively.

Qualifications

• Four years of claims management experience or equivalent education and experience.
• Working knowledge of regulations and disability duration.
• Experience with Public Entity claims preferred.

Responsibilities

• Manage workers compensation claims and determine compensability.
• Negotiate settlements and communicate actions with claimants.
• Ensure proper documentation of claims.

Skills

Analytical skills

Negotiation skills

Communication

Interpersonal skills

Organizational skills

Education

Bachelor's degree from an accredited college or university

Tools

Microsoft Office

Job description

Claims Adjuster - Workers Compensation
Remote CA
2 Months – Contract

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
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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.

QUALIFICATION
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
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
Ability to meet or exceed Service Expectations

Manager's Note
SIP a plus- Must be in California, remote in CA.
Min 3+ years as indemnity examiner handling CA Claims WC experience required.
Prior public entity experience is preferred but not required.