Senior Workers' Compensation Claims Examiner (Contract) (Hybrid or Remote) - CA
Pay Range: $50.25/hour - $55.89/hour depending on candidate experience
Immediate need for a full-time Senior Claims Examiner to support our clients' workers' compensation offices and can be located anywhere in the state of California, The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule.
Job Description:
The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements.
The candidate should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
- Establish contact with employer to review issues
- Respond to inquiries from the employer, employee, doctors, and attorneys
- Establish and maintain appropriate reserves
- Review legal correspondence and medical reports
- Evaluate and approve medical procedures and treatment
- Administer benefits and ensure appropriateness of all payments
- Investigate coverage, liability, and monetary value of claim
- Review medical and legal bills for appropriateness
- Discuss appropriateness of medical treatment with medical case manager
- Determine compensability
- Monitor and assist litigation
- Negotiate settlement of claim, liens, rehabilitation plans, etc.
- Prepare and present reports to clients
- Appropriately close claims
- Help resolve client billing and payment inquiries
- Investigate complaints from injured workers
- Document and code the claim files and claims system with all relevant information
- Maintain and update action plans within specified time frames
- Provide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasks
- Contact with employers, employees, attorneys, doctors, vendors, and other parties
- Provide customer service and support to clients and claimants
- Work collaboratively with attorneys to draft settlements and assist with litigation strategies
- Negotiate settlements
- Authorize and negotiate cost of medical treatment and supplies
- Internal communication with staff
- Prepare professional, well written correspondence and other communications
Position Qualifications:
The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
- High School Diploma or equivalent (GED) required for all positions
- AA/AS or BA/BS preferred but not required
- Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f)
- 3+ years recent workers compensation claims handling experience required
- At least 5 years of workers compensation claims experience preferred
- Solid knowledge of workers compensation laws, policies, and procedures’
- Completion of IEA or equivalent courses
- Proficiency in determining case value and negotiating settlements
- Understanding of medical and legal terminology
- Mathematical calculating skills
- Well-developed verbal and written communication skills with strong attention to detail
- Excellent organizational skills and ability to multi-task
- Ability to type quickly, accurately and for prolonged periods
- Proficient in Microsoft Office Suite
- Ability to learn additional computer programs
- Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
- Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
- Company operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
- Must be able to reliably commute to meetings and events as required by this position
JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.
