Claims Examiner Workers Compensation Specialist
6 days ago
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.
- 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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