Claims Examiner

4 weeks ago


Long Beach, United States Rose International Full time

Date Posted: 05/09/2024

Hiring Organization: Rose International

Position Number: 463794

Job Title: Claims Examiner

Job Location: Long Beach, CA, USA, 90806

Work Model: Hybrid

Employment Type: Temporary

Estimated Duration (In months): 8

Min Hourly Rate ($): 60.00

Max Hourly Rate ($): 60.00

Must Have Skills/Attributes: Claims, Document Review, Negotiation


Job Description


**Only those lawfully authorized to work in the designated country associated with the position will be considered. **


**Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements. **


***Only qualified Claims Examiner candidates located in the Long Beach, CA areas will be considered due to the position requiring an onsite presence***


The client is seeking a qualified Claims Examiner to analyze mid- and higher-level workers compensation claims to determine benefits due, ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.


Required Experience:

• 2 years plus Workers Compensation Claims experience


Preferred Education/Certifications:

• Prefer a college degree

• Prefer SIP certificate


Essential Functions and Responsibilities:

• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency

• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments

• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract

• Manages subrogation of claims and negotiates settlements

• Communicates claim action with claimant and client

• Ensures claim files are properly documented and claims coding is correct

• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review

• Maintains professional client relationships


Additional Functions and Responsibilities:

• Performs other duties as assigned

• Supports the organization's quality program(s)

• Travels as required


Benefits:

For information and details on employment benefits offered with this position, please visit here. Should you have any questions/concerns, please contact our HR Department via our secure website.


California Pay Equity:

For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.


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