Claims Examiner Workers Compensation Specialist

6 days ago


Concord, California, United States Adecco US, Inc. Full time
Job Summary

Adecco US, Inc. is seeking a skilled Claims Examiner Workers Compensation Specialist to join our team. As a key member of our team, you will be responsible for analyzing and managing workers compensation claims to ensure accurate and timely benefits are provided to our clients.

Key Responsibilities
  • Manage workers compensation claims, determining compensability and benefits due, and ensuring ongoing adjudication within company standards and industry best practices.
  • Develop and manage action plans to resolution, coordinate return-to-work efforts, and approve claim payments.
  • Approve and process assigned claims, determine benefits due, and manage action plans pursuant to the claim or client contract.
  • Manage subrogation of claims and negotiate settlements.
  • Communicate claim actions with claimants and clients.
  • Ensure claim files are properly documented and claims coding is correct.
  • May process complex lifetime medical and/or defined period medical claims, including state and physician filings and decisions on appropriate treatments recommended by utilization review.
  • Maintain professional client relationships.
  • Perform other duties as assigned.
  • Support the organization's quality program(s).
  • Travel as required.
Requirements
  • Self-insurance certification is a plus.
  • Bachelor's degree from an accredited college or university preferred.
  • Minimum 3+ years as indemnity examiner handling CA Claims WC experience required.
  • Experience Four (4) years of claims management experience or equivalent combination of education and experience required.
  • Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure 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 skill.
  • Good interpersonal skills.
  • Excellent negotiation skills.
  • Ability to work in a team environment.
  • Ability to meet or exceed.
  • 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.


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