Current jobs related to Claims Adjuster Trainee - Ontario - Trean Corporation

  • MD Telephone Claims Adjuster Trainee

    14 hours ago

    Ontario, New York, United States Allstate Full time

    Job SummaryNational General, a subsidiary of Allstate, is seeking a highly motivated and detail-oriented Claims Adjuster Trainee to join our team. As a Claims Adjuster Trainee, you will be responsible for investigating and confirming the facts of loss for automobile accidents, determining coverage, liability, damages, and adjusting and negotiating claims...

  • Insurance Claims Adjuster

    20 hours ago

    Ontario, California, United States Sedgwick Claims Management Services Full time

    Job SummaryWe are seeking a skilled Claims Adjuster to join our team at Sedgwick Claims Management Services. As a key member of our team, you will be responsible for analyzing mid- and higher-level workers compensation claims to determine benefits due.Key Responsibilities:Analyze claims to determine benefits due and ensure ongoing adjudication within company...

  • MD Telephone Claims Investigator Trainee

    4 days ago

    Ontario, California, United States National General Full time

    MD Telephone Claims Investigator TraineeNational General, a leading insurance company, offers a range of products, including home, auto, and accident and health insurance. As a subsidiary of The Allstate Corporation, we leverage innovative technologies to meet the evolving needs of our customers.We are currently seeking a highly skilled MD Telephone Claims...

  • Claims Examiner

    15 hours ago

    Ontario, California, United States Sedgwick Claims Management Services Full time

    Job Summary:We are seeking a skilled Claims Adjuster to join our team at Sedgwick Claims Management Services. As a key member of our team, you will be responsible for analyzing mid- and higher-level workers compensation claims to determine benefits due.Key Responsibilities:Analyze claims to determine benefits due and ensure ongoing adjudication within...

  • Claims Adjuster

    1 week ago

    Ontario, United States Sedgwick Full time

    **Claims Adjuster - Workers Compensation** **Claims Adjuster - Workers Compensation** **The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.** Claims Adjuster - Workers CompensationIF YOU CARE, THERES A PLACE FOR YOU HERE For a career path that is both...

  • Claims Adjuster

    2 months ago

    Ontario, United States Sedgwick Full time

    **Claims Adjuster - Workers Compensation** **Claims Adjuster - Workers Compensation** **The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.** Claims Adjuster - Workers CompensationIF YOU CARE, THERES A PLACE FOR YOU HERE For a career path that is both...

  • Workers' Compensation Claims Adjuster

    3 months ago

    Ontario, United States AdminSure Inc Full time

    Job DescriptionJob DescriptionEssential Job Functions and Responsibilities:Proven ability to meet industry claims administration standards and timeframesAdministers claims per the California Workers’ Compensation lawsMaintains diary and mail to be currentAdheres to client excess reporting and requests in a timely mannerPrepares Plan of Action towards...

  • Claims Customer Service

    1 month ago

    Ontario, United States Medical Professionals Full time

    The Claims Customer Service Rep is to assist with our members in our Ontario location. This position provides valuable customer service to internal and external customers. The primary function of this role is to review all claims.ResponsibilitiesReviews, research and negotiates the processing and adjusting of claimsProvides excellent customer serviceAnalyze...

  • Healthcare Claims Specialist

    1 week ago

    Ontario, California, United States TotalMed Staffing Full time

    Healthcare Claims Specialist About the Position As a vital member of our team, you will play a key role in ensuring the precise and prompt processing of healthcare claims. Position Details Compensation: $45.72 / hour Location: Ontario, California Profession: Claims Processing Facility Type: Healthcare Specialty: Health Insurance Division: MedFi Key...

  • Claims Examiner

    2 weeks ago

    Ontario, United States NTT DATA Full time

    At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here....

  • Claims Assessment Specialist

    1 week ago

    Ontario, California, United States NTT DATA Full time

    About NTT DATA Services:At NTT DATA, we understand that the right talent is crucial for success. Our employees' dedication and integrity have been pivotal in our growth and market presence. By selecting top-tier professionals and fostering their development, we ensure a prosperous future for both NTT DATA and our workforce. For over 25 years, NTT DATA...

  • Claims Assessment Specialist

    1 week ago

    Ontario, California, United States NTT DATA Full time

    About NTT DATA Services:At NTT DATA, we understand that with the right talent, we can achieve remarkable outcomes. The dedication, integrity, and quality of our workforce have been pivotal in our growth and market influence. By attracting top talent and fostering their professional and personal development, we secure a promising future for both NTT DATA and...

  • Risk Management Professional

    15 hours ago

    Ontario, California, United States Sedgwick Full time

    About the RoleSedgwick is seeking a highly skilled and experienced Claims Adjuster to join our team. As a Claims Adjuster, you will play a critical role in analyzing and resolving workers' compensation claims in a timely and efficient manner.Key ResponsibilitiesClaims Analysis: Conduct thorough investigations and analysis of workers' compensation claims to...

  • Customer Service Representative

    4 days ago

    Ontario, California, United States Medical Professionals Full time

    The Medical Professionals organization is seeking a skilled Customer Service Representative to assist with claims processing in our Ontario location. This role provides valuable support to internal and external customers, ensuring seamless communication and resolution of claims-related inquiries.Key ResponsibilitiesReview and research claims to ensure...

  • Insurance Fraud Investigation Specialist

    1 week ago

    Ontario, California, United States Kemper Full time

    Location: Ontario, CaliforniaCompany Overview:Kemper stands as a prominent name among specialized insurers in the nation. Our achievements are a testament to the skilled and diverse individuals who contribute positively to our customers' lives daily. We foster a high-performance culture that encourages personal growth, professional challenges, and a balanced...

  • Commercial Lines Account Manager

    1 week ago

    Ontario, California, United States RRC Full time

    Position OverviewAs the Commercial Lines Account Manager at RRC, you will play a vital role in nurturing client relationships, providing exceptional insurance solutions, and contributing to the overall growth of the organization.Key Responsibilities:Guide clients through the claims process, ensuring prompt and effective resolution.Serve as the main contact...

  • Insurance Solutions Specialist

    15 hours ago

    Ontario, California, United States RRC Full time

    Job OverviewWe are seeking a highly skilled and experienced Business Development Manager to join our team at RRC. As the Account Executive, Commercial Lines, you will be responsible for fostering client partnerships, delivering premium solutions, and driving business growth through strategic initiatives.Key Responsibilities:Assist clients in the claims...

  • Insurance Account Manager

    17 hours ago

    Ontario, California, United States RRC Full time

    About RRCRRC - Ruiz Recruiting & Consulting is a specialized recruitment firm dedicated to collaborating with startups and enterprise-level companies nationwide. Our mission is to facilitate growth by identifying and attracting exceptional talent.Job SummaryWe are seeking a highly skilled Commercial Lines Account Manager to join our team. As a key member of...

  • Manager, Corporate Payroll

    3 weeks ago

    Ontario, United States Ajinomoto Foods North America Full time

    Overview The Payroll Manager is integral in optimizing payroll processes, ensuring compliance, and fostering a culture of development and governance. As a forward-thinking leader, the Payroll Manager will be pivotal in shaping the payroll function to not only meet current demands but also anticipate future needs and challenges. This role, you will not only...

  • Insurance Sales Representative

    3 months ago

    Ontario, United States Aims Insurance Services, Inc Full time

    Job DescriptionJob DescriptionJoin Aims Insurance Services, Inc, a leading insurance services provider committed to excellence. Our office is located in the vibrant city of Ontario, California. We are a close-knit team dedicated to delivering top-notch service to our valued clients.If you are looking for a dynamic role where you can make a real difference in...

Claims Adjuster Trainee

1 month ago

Ontario, United States Trean Corporation Full time

POSITION SUMMARY:

As a workers' compensation Claims Adjuster Trainee you will go through a 24 week paid training program that at which time will be handling a reduced case load. Upon completion, the trainee would transition into a permanent claim adjuster position handling a full case load. Core responsibilities will be; compensability determinations, administration of benefits and ensure ongoing adjudication of claims within company standards and best practices and comply with all statutory and regulatory requirements for the administration of workers compensation benefits on behalf of the Company. Please note: This position will be remote after training period is completed.

KEY RESPONSIBILITIES AND ESSENTIAL FUNCTIONS:

  1. Complete a 6 week virtual learning training course in conjunction with on the job training.
  2. Upon completion of the virtual learning and on the job training, handle up to 50 workers' compensation claims for the remainder of the training period.
  3. Upon completion of the trainee program, there will be a promotion to Claims Adjuster and increase caseload accordingly.
  4. All new lost time claims require an initial contact with the employer, the injured worker and the medical provider. This must be done within 24 hours of receipt of the claim or notification of a claim.
  5. Ensure that all claim determinations and payments are completed timely including but not limited to, acceptance/denial letters, wage determination letters including required enclosures and appeal forms. In jurisdictions requiring the letters be provided in Spanish and English the adjuster is responsible to make sure all letters are completed
  6. The initial payment of TTD is to be completed within 14 days from the receipt of an accepted claim. Wage information is to be solicited from the employer and either an average weekly wage or average monthly (jurisdiction dependent) be established and the information documented in Origami (Claims System). In the event actual payroll documentation cannot be obtained from the employer an "estimated wage" is established and a payment reconciliation is done when the verified wage is secured. Initial compensation benefits should NOT be delayed due to the failure of the employer to provide wage documentation.
  7. Timely claims determinations for all services including but not limited to: acceptance, denials, authorizations for treatment, benefit payment start, termination are to be included within the statutory or regulatory time frames of the jurisdiction. Denials requiring certified mailing are to be completed timely with appropriate tracking.
  8. Regulatory notices are to be completed timely when required by jurisdictions.
  9. Approvals and denials of medical bills should be completed within 24 hours of receipt so bills can be repriced and paid timely.
  10. Identify the medical providers and medical treatment plan and ensure timely and appropriate medical care is provided to the injured worker. In cases requiring complex or unusual medical care a nurse case manager is to be assigned to facilitate the timely and appropriate care.
  11. All communications with all parties and reference to all determinations and correspondence are to be included in the claim notes of Origami (Claim System).
  12. Manage the legal aspects of the claim and appropriately assign and direct designated attorneys.
  13. Assign claims for investigations, including surveillance, medical surveys and social media checks when required and seek supervisor support on related questions.
  14. Ensure that all bills for various expenses, including legal bills, managed care bills and similar expenses are paid timely or direct claims assistants to pay such when appropriate.
  15. Answer phone calls immediately when in the office. Return all calls and voice mail messages with 24 hrs. Respond to all e-mails when required within 24 hrs.
  16. Direct claims assistants to facilitate adjuster assignments as required. This includes directing clerical staff in duties such as copying documents, scheduling medical appointments for injured workers and filing of documents. Coordinate assignments with the supervisor of the assistants.
  17. Establish a Plan of Action (POA) on each claim and update the POA monthly.
  18. Monitor claims for reinsurance/excess insurance reporting and provide initial reports and quarterly updates on all claims meeting reporting requirements.
  19. Performs other activities, assignments and duties as assigned.
  20. 20. Handle claims according to our best practices


Requirements

  • Bachelor's degree or equivalent education
  • 2-3 years' work experience preferred
  • Excellent analytical skills
  • Strong organizational skills
  • Strong oral and written communication skills


Salary Description

$50,000 to $60,000