Claims Examiner
3 weeks ago
Description:PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
Negotiates settlement of claims within designated authority.
Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
Prepares necessary state fillings within statutory limits.
Manages the litigation process; ensures timely and cost effective claims resolution.
Coordinates vendor referrals for additional investigation and/or litigation management.
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
Ensures claim files are properly documented and claims coding is correct.
Refers cases as appropriate to supervisor and management.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
QUALIFICATION
Education & LicensingBachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
ExperienceFive (5) years of claims management experience or equivalent combination of education and experience required.
Skills & Knowledge
Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations
WORK ENVIRONMENTWhen applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Requirements:
Manager's note:-
5 years of relevant experience
Its remote role. Candidate should be within CA boundry.
Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services.
Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
-
Senior Claims Examiner
2 weeks ago
Long Beach, California, United States TheBest Claims Solutions Full timeWe are seeking a highly skilled Senior Claims Examiner to join our team at TheBest Claims Solutions in Long Beach, California. This is an exciting opportunity for a seasoned professional with extensive experience in handling complex workers' compensation claims.About the Job:The ideal candidate will have 3+ years of experience in managing workers'...
-
Senior Workers Compensation Claims Adjuster
2 months ago
Long Beach, United States TheBest Claims Solutions Full timeOur client, is in need of a Temporary Workers' Compensation Claims Examiner for their Long Beach Office to work on a remote basis. The ideal candidate will have 3+ years of California Workers Compensation Experience.Required Qualifications:3+ years of experience handling Workers' Compensation claims in California.Ability to negotiate settlement of claims...
-
Senior Workers Compensation Claims Adjuster
2 months ago
Long Beach, United States TheBest Claims Solutions Full time $40 - $45Our client, is in need of a Temporary Workers' Compensation Claims Examiner for their Long Beach Office to work on a remote basis. The ideal candidate will have 3+ years of California Workers Compensation Experience.Is this your next job Read the full description below to find out, and do not hesitate to make an application.Required Qualifications:3+ years...
-
Medical Claims Examiner III
2 months ago
Long Beach, United States Ultimate Staffing Full timeResponsibilities:Parameters of the provider's contract obligations.Audit claims processing quality, develops, maintains and runs standard reportsAssist the Claims Supervisor/Director in reviewing the quality auditing tracking/reporting (financial and procedural)Coordinating with various departments to resolve disputes or issuesMaintain the Claims department...
-
Medical Claims Examiner III
1 month ago
Long Beach, United States Ultimate Staffing Full timeResponsibilities:Parameters of the provider's contract obligations.Audit claims processing quality, develops, maintains and runs standard reportsAssist the Claims Supervisor/Director in reviewing the quality auditing tracking/reporting (financial and procedural)Coordinating with various departments to resolve disputes or issuesMaintain the Claims department...
-
Claims Examiner
3 weeks ago
Long Beach, United States Nesco Resource Full timeScroll down to find the complete details of the job offer, including experience required and associated duties and tasks. Description:PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of...
-
Claims Examiner
3 weeks ago
long beach, United States Nesco Resource Full timeDescription:PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify...
-
Insurance Claims Examiner
3 weeks ago
West Palm Beach, Florida, United States Universal Health Services Full timeWe are seeking an experienced Insurance Claims Examiner to join our team at Wellington Regional Medical Center in Wellington, Florida.The estimated annual salary for this position is $55,000-$65,000 depending on experience. Job Description:The Insurance Claims Examiner will be responsible for verifying patient demographic, medical and financial information...
-
Claims Team Lead
3 weeks ago
Long Beach, California, United States Sedgwick Full timeAbout SedgwickSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Our mission is to help our clients protect their brand, minimize business interruptions, and provide exceptional customer experiences. Job Description: Claims Team Lead - Workers CompensationPrimary Responsibilities:Supervise multiple...
-
Nesco Resource | Claims Examiner
2 weeks ago
Long Beach, United States Nesco Resource Full timeDescription:PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify...
-
Commercial Auto GL Property Claims Examiner III
3 weeks ago
West Palm Beach, United States Canon Recruiting Group Full timePOSITION: Commercial Auto, GL & Property Claims Examiner III (It is complex auto and general liability property damage and bodily injury claims, subrogation/recoveries, and first-party property claims desk) FULLTIME LOCATION: West Palm Beach, FL SCHEDULE: Monday-Friday PAY RANGE: $85K-95K/yr. (Exact compensation may vary based on skills, experience, and...
-
Assoc Analyst, Data
6 days ago
Long Beach, United States Molina Healthcare Full time $21 - $40JOB DESCRIPTION Job Summary Designs and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and...
-
Assoc Analyst, Data
6 days ago
Long Beach, United States Molina Healthcare Full time $21 - $40JOB DESCRIPTION Job Summary Designs and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and...
-
Claims Examiner
2 weeks ago
Long Beach, California, United States Sedgwick Full timeAbout UsSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Our mission is to make a positive impact on the world through the people and organizations we serve.
-
Insurance Claims Examiner
3 weeks ago
Daytona Beach, Florida, United States Everstaff Full timeEverstaff is a reputable company seeking a skilled Insurance Processor in Daytona BeachThe estimated salary for this position is $17/hour.Job OverviewThis role involves processing insurance documents and managing email communications with customers and agents.You will be responsible for updating information accurately, learning about insurance document types...
-
Human Resources Specialist
3 weeks ago
Atlantic Beach, United States Orbis Corporation Full timeJob Description:Location: Remote (preferable in Jacksonville, FL but will consider all candidates)Part Time Position This position supports the Naval Sea Systems Command (NAVSEA) Deputy Commander, Total Force/Corporate Operations (SEA 10). NAVSEA is the Department of Navy's (DON's) central activity for designing, engineering, integrating, building, and...
-
Litigation Research Analyst
3 weeks ago
Miami Beach, United States Robert Half Full timeJob DescriptionJob DescriptionWe are looking to add a Litigation Research Analyst to our team located in Miami Beach, Florida, United States. As a Litigation Research Analyst, you will be involved in examining vast amounts of information to determine the narrative for our client base. This role is crucial in our efforts to expand our operations in the Latin...
-
Audiologist
2 weeks ago
Virginia Beach, United States Trusted Medical, LLC Full timeAudiologist Trusted Medical, PLLC About us Trusted Medical, PLLC is the clinical care delivery affiliate of Edera (www.edera.com). We specialize in serving Veterans by reducing wait times for them to gain access to disability screens and separation health assessments required by the Veteran Affairs (VA) to receive benefits. Help serve those who have served...
-
Senior Trial Attorney
2 weeks ago
Virginia Beach, Virginia, United States Allstate Insurance Company Full timeAbout This RoleWe're seeking a skilled and experienced High-Stakes Litigation Expert to join our team at Allstate Insurance Company.This is a high-profile position that requires a strong background in litigation, with a focus on defending bodily injury and property damage lawsuits, subrogation, and Allstate Financial cases.Key ResponsibilitiesConduct...
-
Human Resources Analyst
7 months ago
Hermosa Beach, United States City of Hermosa Beach Isai Full timeDEFINITION Under general direction, to perform a variety of professional level administrative, technical, and analytical duties in support of the City’s Human Resources and Risk Management Division including in the areas of recruitment and selection, employee benefit plans, workers' compensation and general liability claims, and salary and...