Sr. Workers' Compensation Examiner-4850 Claims - CA (Contract - Full Remote)
Pay Range $50.25 - $55.89 based on experience, skills, and location
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.
PRIMARY RESPONSIBILITIES
Our new hire 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
ESSENTIAL POSITION REQUIREMENTS
High School Diploma or equivalent (GED) required for all positions
AA/AS or BA/BS preferred but not required
Administrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtained
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)
5+ years recent workers compensation claims handling experience required
3+ years' experience with 4850 Claims
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
Our clients 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.
***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.***
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