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Sr. Workers' Compensation Claims Adjuster

4 months ago

Long Beach, United States Elite Services Full time
This position will be a remote position.

Must have a California SIP (Workers Compensation - Sr. Work Comp Claims Adjuster)
Must be Bilingual (English/Spanish)

POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

DUTIES AND RESPONSIBILITIES:
  • Effectively manages a caseload of 130 to 140 workers' compensation files, including very complex claims.
  • Initiates and conducts investigation in a timely manner.
  • Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
  • Manages medical treatment and medical billing, authorizing as appropriate.
  • Refers cases to outside defense counsel. Directs and manages as appropriate.
  • Communicates with claimants, providers and vendors regarding claims issues.
  • Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.
  • Settles and/or finalize all claims and obtains authority as designated.
  • Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
  • Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
  • Adheres to all Company policies and procedures.
  • Conducts file reviews independently.
  • Other duties as assigned.
* Essential job function.

EQUIPMENT OPERATED/USED: Computer, fax machine, copier, printer, and other office equipment.

QUALIFICATIONS REQUIRED:

Education/Experience: Bachelor's degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities:
  • Technical knowledge of statutory regulations and medical terminology.
  • Analytical skills.
  • Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
  • Ability to interact with persons at all levels in the business environment.
  • Ability to independently and effectively manage very complex claims.
  • Proficient in Word and Excel (preferred).
Other Qualifications:
  • Certifications and/or licenses as required by State regulation.
Here are some of the benefits you can enjoy in this role:
  • Medical, Dental, Vision, Disability & Life Insurance
  • 401(k) plan
  • Paid time off
  • Paid holidays