Claims Examiner

2 weeks ago

Signal Hill, California, United States Synectics Inc Full time
Job Summary

We are seeking a skilled Claims Associate to join our team at Synectics Inc. The ideal candidate will have a strong background in claims management and excellent communication skills.

Key Responsibilities

  • Process and adjudicate workers compensation claims to determine benefits due, ensuring compliance with company standards and industry best practices.

  • Develop and coordinate action plans to resolution, return-to-work efforts, and approve claim payments.

  • Administer subrogation of claims and negotiate settlements with clients.

  • Communicate claim actions with claimants and clients, ensuring timely and effective communication.

  • Ensure claim files are properly documented and claims coding is accurate.

  • May process low-level lifetime medical and/or defined period medical claims, including state and physician filings and decisions on appropriate treatments.

  • Maintain professional relationships with clients and stakeholders.

  • Perform other duties as assigned to support the organization's quality program.

Requirements

  • Bachelor's degree from an accredited college or university preferred.

  • 2 years of claims management experience or equivalent combination of education and experience required.

  • Developing knowledge of regulations, offsets, and deductions, disability duration, medical management practices, and Social Security and Medicare application procedures.

  • Excellent oral and written communication skills, including presentation skills.

  • PC literate, including Microsoft Office products.

  • Analytical and interpretive skills.

  • Strong organizational skills.

  • Good interpersonal skills.

  • Ability to work in a team environment.

  • Ability to meet or exceed Service Expectations.

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