Sr. Claims Specialist
2 weeks ago
Notes:
- Remote in CA - Candidate has to be physically located in CA.
- Temp to perm possibility.
- SIP is nice to have but not required
- Years of experience required: 5+
- Public agency & self-insured account experience is desirable.
Primary Purpose:
To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
Responsibilities
- Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
- Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
- May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
Qualifications
- Bachelor's degree from an accredited college or university preferred.
- Experience Four (4) years of claims management experience or equivalent combination of education and experience required.
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