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Workers Compensation Claims Examiner Level III
1 month ago
Workers Compensation Claims Examiner Level III - Chino Hills, CA - Medical Billing & Coding Description: This is a direct hire position for two Workers Compensation Claims Examiners Level III, offering a salary range of $75,000 to $95,000. The role is remote, but the successful candidates will report to the Chino Hills Branch office. This role requires a minimum of 3 years of experience in Workers Compensation Claims Administration and a CA SIP (Self Insured Plans Certification). The successful candidates must reside in California. The caseload will include about 150 -180 workers' compensation files, including very complex claims. Responsibilities: Effectively manage a caseload of 150 to 180 workers’ compensation files, including very complex claims. Initiate and conduct investigations in a timely manner. Determine compensability of claims and administer benefits, based on state law and established Company guidelines. Manage medical treatment and medical billing, authorizing as appropriate. Refer cases to outside defense counsel and manage as appropriate. Communicate with claimants, providers, and vendors regarding claims issues. Compute and set reserves within Company guidelines. Settle and/or finalize all claims and obtain authority as designated. Maintain diary system for case review and document file to reflect the status and work being performed on the file. Communicate appropriate information promptly to the client to resolve claims efficiently. Adhere to all Company policies and procedures. Conduct file reviews independently. Perform other duties as assigned. Requirements: Bachelor’s degree in a related field (preferred) or equivalent combination of education and experience. Five (5) or more years of CA Workers compensation claims experience. Technical knowledge of statutory regulations and medical terminology. Analytical skills. Excellent written and verbal communication skills. Ability to interact with persons at all levels in the business environment. Ability to independently and effectively manage very complex claims. Proficiency in Word and Excel (preferred). Certifications and/or licenses as required by State regulation. Benefits: Medical, Dental, Vision, Disability & Life insurance 401(k) plan Paid time off Paid holidays. San Bernardino County 601 S. Milliken Avenue, Suite A Ontario, CA 91761 Orange County 1970 Old Tustin Avenue, Suite C Santa Ana, CA 92705 Riverside County 27645 Jefferson Avenue, Suite 116 Temecula, CA 92590 #J-18808-Ljbffr
