Claims Adjuster-Workers Compensation - Remote / Telecommute

Cynet Systems Inc; Sacramento (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

A forward-thinking company is seeking a skilled Claims Manager to oversee workers' compensation claims. In this role, you will manage claims from initiation to resolution, ensuring compliance with regulations and maintaining professional client relationships. Your analytical and negotiation skills will be vital as you develop action plans and coordinate return-to-work efforts. Join a dynamic team where your expertise will contribute to the success of the organization and make a real difference in the lives of clients. If you are passionate about claims management and ready to take on new challenges, this opportunity is perfect for you.

Qualifications

• Bachelor's degree preferred; 4 years of claims management experience required.
• Strong knowledge of workers' compensation regulations and practices.

Responsibilities

• Manage workers' compensation claims and develop action plans for resolution.
• Coordinate return-to-work efforts and negotiate settlements.

Skills

Claims Management

Communication Skills

Analytical Skills

Negotiation Skills

Organizational Skills

Interpersonal Skills

Teamwork

Education

Bachelor's Degree

4+ Years of Claims Management Experience

Tools

Microsoft Office

Job description

Job Description

Pay Range: $40/hr - $45/hr

Responsibilities:

1. Manages workers' compensation claims, determining compensability and benefits due on long-term indemnity claims, monitoring reserve accuracy, and filing necessary documentation with state agencies.
2. Develops and manages 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 plans according to the claim or client contract.
4. Manages subrogation of claims and negotiates settlements. Communicates claim actions with claimants and clients.
5. Ensures claim files are properly documented and claims coding is correct.
6. May process complex lifetime medical and/or defined period medical claims, including state and physician filings and decisions on treatments recommended by utilization review.
7. Maintains professional client relationships.

Qualifications

Education and Licensing:

• Bachelor's degree from an accredited college or university preferred.
• Four (4) years of claims management experience or an equivalent combination of education and experience required.

Skills and Knowledge:

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

Preferred/Needed Skills:

• Minimum of 3+ years as an indemnity examiner handling workers' compensation claims.
• Prior public entity experience is preferred but not required.