Workers' Compensation Claims Examiner

Preferred Home Health Care & Nursing Services; Temescal Valley (CA); On-site; USD 60,000 - 90,000; Full time

Job summary

Preferred Home Health Care & Nursing Services is seeking a detail-oriented professional to administer medical-only workers’ compensation claims. You will investigate injuries, determine compensability, and ensure accurate processing of medical bills and reimbursements while maintaining complete claim records.

This role requires strong regulatory knowledge and excellent communication with clients and injured workers.

Qualifications

• Knowledge of workers’ compensation claims administration and medical-only claim processing.
• Ability to evaluate injuries for compensability and document findings clearly.
• Detail-oriented recordkeeping and accurate processing of billing/reimbursement information.
• Excellent communication and customer service skills for client and injured worker support.
• Solid understanding of regulatory compliance expectations.

Responsibilities

• Investigate workplace injuries and determine compensability.
• Process medical bills and benefit reimbursements.
• Maintain accurate, complete, and up-to-date claim records.
• Provide timely, high-quality service to clients and injured workers.
• Ensure all claim handling activities meet applicable regulatory and compliance requirements.

Skills

Work comp claims

Regulatory compliance

Billing/reimbursement

Documentation/recordkeeping

Client/customer service

Job description

Role: Administer medical-only workers’ compensation claims with a focus on accurate investigation, regulatory compliance, and responsive client service.

Key Responsibilities

• Investigate workplace injuries and determine compensability.
• Process medical bills and benefit reimbursements.
• Maintain accurate, complete, and up-to-date claim records.
• Provide timely, high-quality service to clients and injured workers.
• Ensure all claim handling activities meet applicable regulatory and compliance requirements.
  

Qualifications & Skills

• Strong knowledge of workers’ compensation claims administration and medical-only claim processing.
• Ability to evaluate injuries for compensability and document findings clearly.
• Detail-oriented recordkeeping and accurate processing of billing/reimbursement information.
• Excellent communication and customer service skills for client and injured worker support.
• Solid understanding of regulatory compliance expectations.