Current jobs related to Claims Adjuster- California Workers' Compensation - Lewisville - Method Workers Compensation LLC
-
Senior Claims Adjuster
1 month ago
Lewisville, Texas, United States Method Workers Compensation LLC Full timeJob Title: Senior Claims Adjuster - CaliforniaMethod Workers' Compensation LLC is seeking a highly skilled Senior Claims Adjuster to join our team in California. As a Senior Claims Adjuster, you will be responsible for analyzing claims to determine benefits due, ensuring the ongoing adjudication of claims within service expectations, industry, and company...
-
Premium Audit Reviewer
4 weeks ago
Lewisville, Texas, United States Method Workers Compensation LLC Full timeJob OverviewMethod Workers' Compensation is seeking a skilled Premium Audit Reviewer to join our team. As a Premium Audit Reviewer, you will play a critical role in ensuring the accuracy and compliance of workers' compensation insurance premium audits.Key ResponsibilitiesReview and analyze premium audits to ensure accuracy and compliance with company,...
-
Commercial Large Loss Com Claims General Adjuster
4 months ago
Lewisville, United States Zurich Insurance Company Full timeZurich North America is currently searching for an experienced property claims professional to join our large loss property claims team. We are open to remote work for the right candidate located any western states of TX, OK, LA, AR, KS, MO, NE, IL, MN, WI, CO, NM, AZ, NV, UT, OR, WA, or WI. The Property Claims organization is dedicated to helping our...
-
Commercial Large Loss Claims Specialist
2 weeks ago
Lewisville, Texas, United States Zurich Insurance Company Full timeCommercial Property Claims AdjusterZurich North America is seeking an experienced property claims professional to join our large loss property claims team. We are open to remote work for the right candidate located in the western states of TX, OK, LA, AR, KS, MO, NE, IL, MN, WI, CO, NM, AZ, NV, UT, OR, WA, or WI.The Property Claims organization is dedicated...
-
Insurance Claims Specialist
6 days ago
Lewisville, Texas, United States StoneGate Senior Living Full timeInsurance Biller Job DescriptionStoneGate Senior Living is seeking an experienced Insurance Biller to join our team. As an Insurance Biller, you will be responsible for verifying and facilitating insurance authorizations for Skilled Nursing patients.Key Responsibilities:Verify insurance benefits and obtain preauthorization for Skilled Nursing...
-
Medical Billing Specialist
6 days ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryThe Medical Biller will be responsible for performing all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims. This role requires strong analytical and problem-solving skills, as well as excellent communication and interpersonal skills.Key Responsibilities Correcting and billing...
-
Patient Account Representative
3 months ago
LEWISVILLE, United States Guidehouse Full timeJob Family:Patient Account RepresentativeTravel Required:NoneClearance Required:NoneWhat You Will Do:The Patient Account Representative (PAR) is expected to perform specific billing processes, follow-up, account resolution, adjustments and scanning as required. This position works with other departments to facilitate the meeting of both departmental facility...
-
Patient Account Representative
2 days ago
LEWISVILLE, United States Guidehouse Full timeJob Family:Patient Account RepresentativeTravel Required:NoneClearance Required:NoneWhat You Will Do:The Patient Account Representative (PAR) is expected to perform specific billing processes, follow-up, account resolution, adjustments and scanning as required. This position works with other departments to facilitate the meeting of both departmental facility...
-
Patient Account Representative
2 months ago
LEWISVILLE, United States Guidehouse Full timeJob Family:Patient Account RepresentativeTravel Required:NoneClearance Required:NoneWhat You Will Do:The Patient Account Representative (PAR) is expected to perform specific billing processes, follow-up, account resolution, adjustments and scanning as required. This position works with other departments to facilitate the meeting of both departmental facility...
-
Patient Account Representative
3 months ago
LEWISVILLE, United States Guidehouse Full timeJob Family:Patient Account RepresentativeTravel Required:NoneClearance Required:NoneWhat You Will Do:The Patient Account Representative (PAR) is expected to perform specific billing processes, follow-up, account resolution, adjustments and scanning as required. This position works with other departments to facilitate the meeting of both departmental facility...
-
Licensed Clinical Social Worker
2 weeks ago
Lewisville, Texas, United States Collage Home and Community Rehabilitation Partners Full timeOverviewCollage Home and Community Rehabilitation Partners is a dynamic organization dedicated to providing exceptional neurological rehabilitation. We offer a unique approach to treatment, focusing on patient-centered care in the comfort of their own homes and communities.ResponsibilitiesAs a Licensed Clinical Social Worker, you will be responsible...
-
Hybrid AR Specialist
1 month ago
Lewisville, United States Medix Full timeJob DescriptionJob DescriptionMedix's Lewisville-based client is looking for Experienced AR Representatives! Apply if qualified and interested!Contract to hire opportunity (6 months)Hybrid Opportunity (2 days in office; 3 days remote)Official Title: Ambulatory Follow Up RepresentativeDay to day:Working in NextGen/GPMS systemProvider billing/collections...
-
Medical Biller
2 weeks ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryWe are seeking a skilled Medical Biller to join our team at Guidehouse. As a Medical Biller, you will be responsible for performing all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims.You will work closely with other departments to facilitate the meeting of both departmental and...
-
Field Case Manager
2 weeks ago
Lewisville, North Carolina, United States Genex Services Full timeJob Title: Field Case ManagerCompany Overview:Genex Services is a leading provider of workers' compensation and disability management solutions. Our organization is dedicated to helping individuals recover from injuries and return to work safely and efficiently.Job Description:We are seeking a highly skilled and compassionate Field Case Manager to join our...
-
Medical Biller
1 month ago
Lewisville, Texas, United States Guidehouse Full timeAbout the RoleWe are seeking a skilled Medical Biller to join our team at Guidehouse. As a Medical Biller, you will play a critical role in ensuring the accurate and timely processing of healthcare claims.Key ResponsibilitiesPerform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims.Work with...
-
Patient Account Representative
2 weeks ago
Lewisville, Texas, United States Guidehouse Full timeAbout the RoleWe are seeking a highly skilled Patient Account Representative to join our team at Guidehouse. As a key member of our revenue cycle team, you will be responsible for performing specific billing processes, follow-up, account resolution, adjustments, and scanning as required.Key ResponsibilitiesContacts third-party payers and guarantors via payer...
-
Patient Account Representative
2 weeks ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryThe Patient Account Representative will be responsible for performing specific billing processes, follow-up, account resolution, adjustments, and scanning as required. This position will work with other departments to facilitate the meeting of both departmental facility goals and objectives.Key ResponsibilitiesContacts third-party payers and...
-
Patient Account Representative
2 weeks ago
Lewisville, Texas, United States Guidehouse Full timeJob SummaryThe Insurance Patient Account Representative is a key member of our client's business office staff, responsible for resolving account balances with patients and insurance companies. This role requires strong communication and problem-solving skills, as well as the ability to work independently with minimal supervision.Key ResponsibilitiesResolve...
-
CT/Rad Tech, RT(R), CT, ARRT
5 months ago
Lewisville, United States All Med Search Full timeJob Duties and Responsibilities: · Participates in hospital or departmental performance improvement activities. · Prepares patient for exams. · Processes image in accordance with industry standards and techniques. · Follows prescribed techniques in administering CT procedure/exam...
-
Patient Account Representative
2 days ago
LEWISVILLE, United States Guidehouse Full timeJob Family:Patient Account RepresentativeTravel Required:NoneClearance Required:NoneWhat You Will Do: The Insurance Patient Account Representative is an extension of a client’s business office staff. Representatives are responsible for taking in-coming and making out-going calls to patients and insurance companies to resolve account balances. All client...
Claims Adjuster- California Workers' Compensation
2 months ago
Who We Are
Method Workers’ Compensation is a portfolio of workers’ comp companies with the same mission: minimizing the human and financial cost of workplace injuries. We mitigate workplace injuries and deliver exceptional healthcare outcomes for injured workers, expediting a return to work, preserving families’ livelihoods, and enhancing employers’ productivity. We maintain in-house expertise in claims management, medical bill review, underwriting, and loss prevention for high-hazard, high-mod, and mid-market risks. From submission to claim, we’re there every step of the way, improving outcomes for everyone involved. Method currently operates in all states.
What To Expect
The Claims Adjuster is primarily responsible for analyzing workers' compensation claims to determine the benefits due. This role is also responsible for ensuring the ongoing adjudication of claims within service expectations and company best practices pursuant to all state, legal, statutory, and regulatory bodies. This is a full-time, salaried exempt position with standard business hours of Monday through Friday from 8:00am to 5:00pm, with some flexibility at manager’s discretion.
What You’ll Do
- With minimal supervision, investigate claims, including but not limited to reviewing the first report of injuries, medical records; contracts; contacting insureds, injured workers, medical providers, and other parties to determine compensability in a timely manner.
- Understands, analyzes, and applies policy components to evaluate coverage.
- Ensure compliance of claims handling requirements pursuant to all state, legal, statutory and regulatory bodies.
- Exercise discretion and independent judgment with respect to evaluating and managing claims, including determining reserve amounts and document rationale.
- Evaluate exposure of claims by reviewing medical records and claim facts to determine causal relatedness of medical conditions.
- Manage the medical treatment and return to work process throughout the life of the claim.
- Adhere to Method Best Practices, Method Claims Protocol, and Claims Handling Guidelines.
- Maintain appropriate claim file documentation and accurate claim coding.
- Communicate claim activity regularly to any relevant internal and external stakeholders, including injured workers, policyholders, medical providers, and carriers, when appropriate.
- Timely prepare state filings within the state statutory regulations.
- Calculate the average weekly wage and indemnity benefits owed.
- Ensure all benefits are paid timely and in accordance with jurisdictional requirements.
- Exercise accurate discernment and decision-making to analyze claims exposure and to plan and document the proper course of action to move the claim to resolution.
- Coordinate vendor utilization while considering claim cost containment techniques and outcomes, including but not limited to nurse case management, surveillance, etc.
- Manage claim recoveries, including but not limited to Second Injury Fund, subrogation, and Medicare offsets.
- Notify management of large loss exposure, denial, coverage disputes, subrogation potential, or other matters requiring escalation or collaboration.
- Maintain knowledge of jurisdictional requirements and applicable case law for each State, including appropriate licensure and continuing education requirements.
- Perform other duties as requested and assigned.
What You Need
- In-depth knowledge of workers' compensation insurance principles and laws, as well as cost containment principles
- Strong analytical, critical thinking, and problem-solving skills
- Detail-oriented with the ability to work in a team environment
- Excellent customer service, written and verbal communication skills
- Ability to prioritize and balance multiple projects simultaneously
- Results-driven, proactive, and able to work autonomously
- Ability to exercise discretion and independent judgment
- Proficient in Microsoft Office Suite, PDF Professional, G Suite, or similar software.
- A combination of education and experience in a TPA or brokerage environment will be considered
- State adjuster’s licenses as required
Preferred Experience
- At least 1-4 years of experience in workers’ compensation claims experience is preferred
- Bachelor’s degree from an accredited college or university
- Bilingual in Spanish is a plus
What We Offer:
In exchange for your time and expertise, we offer competitive compensation, 401(k) plus matching, health benefits (including HSA Contribution), paid disability, paid parental leave, professional development opportunities, and a hybrid/remote work environment. This is an opportunity to play a key role in the continued success of a growing organization.
Unless fully remote, this position operates in a professional office setting and routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. This is largely a sedentary role with prolonged periods of sitting at a desk and working on a computer. However, some filing is necessary and may require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary.
Method Workers’ Compensation is an equal opportunity employer regardless of race, color, gender, age, sexual orientation, gender identity, gender expression, religious beliefs, marital status, genetic information, national origin, disability, protected veteran status, or any other basis protected by federal, state, or local law.
