Looking for Sr. Claims Specialist

2 weeks ago


Concord, United States ALOIS LLC Full time
Job DescriptionJob Description

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 (5+) years of claims management experience or equivalent combination of education and experience required.


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