Claims Specialist

1 day ago


Long Beach, California, United States Cynet Systems Full time
Job Title: Claims Associate

Job Summary:
Cynet Systems is seeking a skilled Claims Associate to join our team. As a Claims Associate, you will be responsible for processing low-level workers compensation claims, determining compensability and benefits due, and administering action plans to resolution.

Key Responsibilities:
  1. Process low-level workers compensation claims, determining compensability and benefits due, and administering action plans to resolution.
  2. Develop and coordinate low-level workers compensation claims' action plans to resolution, return-to-work efforts, and approve claim payments.
  3. Approve and process assigned claims, determine benefits due, and administer action plan pursuant to the claim or client contract.
  4. Administer subrogation of claims and negotiate settlements.
  5. Communicate claim action with claimant and client.
  6. Ensure claim files are properly documented and claims coding is correct.
  7. May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.

Requirements:
  1. Bachelor's degree from an accredited college or university preferred.
  2. Two years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.

Skills and Knowledge:
  • Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices.
  • 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 skills.
  • Good interpersonal skills.
  • Ability to work in a team environment.
  • Ability to meet or exceed Service Expectations.


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