Sr. Workers' Compensation Claims Adjuster

Elite Tek Services, Inc.; Long Beach (CA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Disability & Life Insurance

401(k) plan

Paid time off

Paid holidays

Job summary

A leading claims management firm is seeking a Sr. Work Comp Claims Adjuster to manage complex indemnity claims. This remote position requires a minimum of 5 years of experience and bilingual skills in English and Spanish. You will be responsible for investigating claims, managing medical treatments, and communicating effectively with clients and claimants. The firm offers comprehensive benefits including medical, dental, vision, and paid time off.

Qualifications

• Five or more years related experience or equivalent combination of education and experience.
• Certifications and/or licenses as required by State regulation.

Responsibilities

• Manage all aspects of indemnity claims handling from inception to conclusion.
• Investigate claims and determine compensability.
• Manage medical treatment and billing.
• Communicate with claimants, providers, and vendors regarding claims issues.

Skills

Bilingual (English/Spanish)

Analytical skills

Excellent written and verbal communication skills

Technical knowledge of statutory regulations

Ability to manage very complex claims

Education

Bachelor’s degree in related field

Tools

Word

Excel

Job description

Overview

This position will be a remote position.

Must have a California SIP (Workers Compensation - Sr. Work Comp Claims Adjuster)
Must be Bilingual (English/Spanish)

POSITION SUMMARY

Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

DUTIES AND RESPONSIBILITIES

• Effectively manages a caseload of 130 to 140 workers’ compensation files, including very complex claims.
• Initiates and conducts investigation in a timely manner.
• Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel. Directs and manages as appropriate.
• Communicates with claimants, providers and vendors regarding claims issues.
• Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.
• Settles and/or finalize all claims and obtains authority as designated.
• Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
• Adheres to all Company policies and procedures.
• Conducts file reviews independently.
• Other duties as assigned.

Essential job function.

EQUIPMENT OPERATED/USED

Computer, fax machine, copier, printer, and other office equipment.

QUALIFICATIONS REQUIRED

Education/Experience: Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).

Other Qualifications

• Certifications and/or licenses as required by State regulation.

Benefits

• Medical, Dental, Vision, Disability & Life Insurance
• 401(k) plan
• Paid time off
• Paid holidays