Claims Representative
2 weeks ago
All the relevant skills, qualifications and experience that a successful applicant will need are listed in the following description.
Description:
Looking for an experienced examiner to handle a heavy complex claims desk with mainly litigated claims. I want someone who can move fast and is good at closing claims. This is one of our more complex desks on the team working for a prestigious client so I need someone who is reliable and has good references.
Self Insurance Plans Certificate.
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:-
Self Insurance Plans Certificate.
Work location: Possibly remote but only in CA. Ideal is if we had someone close to the office that could come in one day a week with the rest of the team to help answer questions and training.
Years of experience required: at least 5 year of experience
Any specific skill/ certifications/ license/ experience: SIP license.
Number of case load: 140. They are not going to get a lot of new losses on this desk unless we get swamped as this is our busy period. The goal of the desk is to settle as many of the older claims as possible.
JURIS if possible, located in CA, SIP license.
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.
-
Claims Representative
4 weeks ago
Concord, United States Sedgwick Claims Management Services Full timeTo process low 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 with general su Claims Representative, Claims, Workers Compensation, Worker, Representative, Client Relations, Insurance
-
Total Loss Claims Representative
4 weeks ago
Concord, United States Plymouth Rock Assurance Full timeOverview: The Total Loss Unit within our Claims Organization is responsible for identifying, negotiating and settling total losses with both insureds and claimants. The Total Loss Claim Representative processes payments and is responsible for the documentation of assigned claims as well as coordinate disposition of the total loss salvage vehicle. He/she is...
-
Claim Representative
1 month ago
Concord, United States Sedgwick Full timeTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your...
-
Claims Representative
1 week ago
concord, United States Nesco Resource Full timeDescription: Looking for an experienced examiner to handle a heavy complex claims desk with mainly litigated claims. I want someone who can move fast and is good at closing claims. This is one of our more complex desks on the team working for a prestigious client so I need someone who is reliable and has good references. Self Insurance Plans Certificate....
-
Claims Representative
2 weeks ago
concord, United States Nesco Resource Full timeDescription: Looking for an experienced examiner to handle a heavy complex claims desk with mainly litigated claims. I want someone who can move fast and is good at closing claims. This is one of our more complex desks on the team working for a prestigious client so I need someone who is reliable and has good references. Self Insurance Plans Certificate....
-
Liability Claims Advisor
3 months ago
Concord, United States Nesco Resource Full timeDescription:Candidate present in PST state can be submitted but has to have min 3 - 5 years of CA claims handling experience.Remote in CA - first preference and then pst state.Candidate needs to attend the trail in whichever CA city trial is scheduled.min 5 years of CA Liability experience and min 3 years of Medical Malpractice experience.ExperienceJuris...
-
Liability Claims Advisor
5 days ago
concord, United States Nesco Resource Full timeDescription:Candidate present in PST state can be submitted but has to have min 3 - 5 years of CA claims handling experience.Remote in CA - first preference and then pst state.Candidate needs to attend the trail in whichever CA city trial is scheduled.min 5 years of CA Liability experience and min 3 years of Medical Malpractice experience.ExperienceJuris...
-
Liability Claims Advisor
6 days ago
concord, United States Nesco Resource Full timeDescription:Candidate present in PST state can be submitted but has to have min 3 - 5 years of CA claims handling experience.Remote in CA - first preference and then pst state.Candidate needs to attend the trail in whichever CA city trial is scheduled.min 5 years of CA Liability experience and min 3 years of Medical Malpractice experience.ExperienceJuris...
-
Claims Associate
3 weeks ago
Concord, United States Sedgwick Full timeTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your...
-
Nesco Resource | Claims Representative
4 days ago
Concord, United States Nesco Resource Full timeDescription: Looking for an experienced examiner to handle a heavy complex claims desk with mainly litigated claims. I want someone who can move fast and is good at closing claims. This is one of our more complex desks on the team working for a prestigious client so I need someone who is reliable and has good references. Self Insurance Plans Certificate....
-
Nesco Resource | Liability Claims Advisor
5 days ago
concord, United States Nesco Resource Full timeDescription:Candidate present in PST state can be submitted but has to have min 3 - 5 years of CA claims handling experience.Remote in CA - first preference and then pst state.Candidate needs to attend the trail in whichever CA city trial is scheduled.min 5 years of CA Liability experience and min 3 years of Medical Malpractice experience.ExperienceJuris...
-
Insurance Sales Representative
1 week ago
Concord, United States Alchemy Financial Group Full timeAbout the Insurance Sales Representative position We are looking for a competitive Insurance Sales Representative to help us expand our business by actively seeking and acquiring new clients. You will identify their needs and demands and sell accordingly. The goal is to formulate strong relationships to ensure growth and preserve and augment our firm's...
-
Claims Representative
1 week ago
Concord, CA, United States Nesco Resource Full timeDescription: Looking for an experienced examiner to handle a heavy complex claims desk with mainly litigated claims. I want someone who can move fast and is good at closing claims. This is one of our more complex desks on the team working for a prestigious client so I need someone who is reliable and has good references. Self Insurance Plans Certificate....
-
Medical Customer Service Representative
1 week ago
Concord, New Hampshire, United States Randstad US Full timeAbout Randstad USRandstad US is a world leader in matching great people with great companies. Our experienced agents work diligently to match your skills and qualifications to the right job and company.Job SummaryWe are seeking a skilled Medical Customer Service Representative to join our team at a well-known company in Concord, NH. As a Medical Customer...
-
Customer Service Representative
5 days ago
Concord, New Hampshire, United States Randstad US Full timeAbout the RoleRandstad US is partnering with a well-known company in Concord, NH to fill a Customer Service Representative position. This role involves interacting with customers, responding to inquiries, and resolving billing issues.Key Responsibilities- Responds to customer inquiries via phone and email- Researches claims and coordinates information from...
-
Concord, United States Northeast Delta Dental Full timeNortheast Delta Dental in Concord, NH is looking to hire a full-time, onsite, Dental Insurance Customer Service Representative. We are a customer service focused organization, and we highly value strong customer service representatives as you have the opportunity to make a difference at the front lines of our organization. Our Dental Insurance Customer...
-
Customer Service Representative
2 days ago
Concord, United States Ultimate Staffing Full timePay: $21.00 - $23.00/hour (based on experience) Hours: Monday - Friday, 8:50 AM - 5:00 PM (37.5 hour work week) Location: Concord, NH (100% on-site) Our client is seeking a dedicated Customer Service Representative with solid office experience, including phone-based customer support. Medical or Dental industry preferred but not required Duties and...
-
Customer Service Representative
1 month ago
Concord, United States Ultimate Staffing Full timePay: $21.00 - $23.00/hour (based on experience)Hours: Monday - Friday, 8:50 AM - 5:00 PM (37.5 hour work week)Location: Concord, NH (100% on-site) Our client is seeking a dedicated Customer Service Representative with solid office experience, including phone-based customer support. Medical or Dental industry preferred but not required Duties and...
-
Customer Service Representative
4 weeks ago
Concord, United States Ultimate Staffing Full timePay: $21.00 - $23.00/hour (based on experience)Hours: Monday - Friday, 8:50 AM - 5:00 PM (37.5 hour work week)Location: Concord, NH (100% on-site) Our client is seeking a dedicated Customer Service Representative with solid office experience, including phone-based customer support. Medical or Dental industry preferred but not required Duties and...
-
Customer Service Representative
3 weeks ago
Concord, United States Ultimate Staffing Full timePay: $21.00 - $23.00/hour (based on experience) Hours: Monday - Friday, 8:50 AM - 5:00 PM (37.5 hour work week) Location: Concord, NH (100% on-site) Our client is seeking a dedicated Customer Service Representative with solid office experience, including phone-based customer support. Medical or Dental industry preferred but not required Duties and...
