Remote Claims Examiner - Workers Compensation Asso
Company: AppleOne
Location: Long Beach
Posted on: May 14, 2022
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Job Description:
Job DescriptionA major client of mine in the Long Beach CA area
is seeking a Claims Adjuster. The primary purpose for this role is
analyze complex or technically difficult workers' compensation
claims to determine benefits due; to work with high exposure claims
involving litigation and rehabilitation; to ensure ongoing
adjudication of claims within service expectations, industry best
practices and specific client service requirements; and to identify
subrogation of claims and negotiate settlements. Below are the full
details for this great opportunity so please read and tell me if
you would like to move to the next step. Also, to be considered an
updated resume is a MUST!!!!Schedule: Monday-Friday 37.50-40 hours
per weekPay Rate: $40.00Duration:3-6 monthsThis is a remote
position!!!!ESSENTIAL FUNCTIONS and RESPONSIBILITIESAnalyzes and
processes complex or technically difficult workers' compensation
claims by investigating and gathering information to determine the
exposure on the claim; manages claims through well-developed action
plans to an appropriate and timely resolution.Negotiates settlement
of claims within designated authority.Calculates and assigns timely
and appropriate reserves to claims; manages reserve adequacy
throughout the life of the claim.Calculates and pays benefits due;
approves and makes timely claim payments and adjustments; and
settles clams within designated authority level.Prepares necessary
state fillings within statutory limits.Manages the litigation
process; ensures timely and cost effective claims
resolution.Coordinates vendor referrals for additional
investigation and/or litigation management.Uses appropriate cost
containment techniques including strategic vendor partnerships to
reduce overall cost of claims for our clients.Manages claim
recoveries, including but not limited to: subrogation, Second
Injury Fund excess recoveries and Social Security and Medicare
offsets.Reports claims to the excess carrier; responds to requests
of directions in a professional and timely manner.Communicates
claim activity and processing with the claimant and the client;
maintains professional client relationships.Ensures claim files are
properly documented and claims coding is correct.Refers cases as
appropriate to supervisor and management.ADDITIONAL FUNCTIONS and
RESPONSIBILITIESPerforms other duties as assigned.Supports the
organization's quality program(s).Travels as
required.QUALIFICATIONEducation & Licensing Bachelor•s degree from
an accredited college or university preferred. Professional
certification as applicable to line of business
preferred.Experience Five (5) years of claims management experience
or equivalent combination of education and experience
required.Skills & KnowledgeSubject matter expert of appropriate
insurance principles and laws for line-of-business handled,
recoveries offsets and deductions, claim and disability duration,
cost containment principles including medical management practices
and Social Security and Medicare application procedures as
applicable to line-of-business.Excellent oral and written
communication, including presentation skillsPC literate, including
Microsoft Office productsAnalytical and interpretive skillsStrong
organizational skillsGood interpersonal skillsExcellent negotiation
skillsAbility to work in a team environmentAbility to meet or
exceed Service Expectations AppleOne is proud to be an Equal
Opportunity Employer. Pursuant to applicable state and municipal
Fair Chance Laws and Ordinances, we will consider for employment
qualified applicants with arrest and conviction records.
Keywords: AppleOne, Long Beach , Remote Claims Examiner - Workers Compensation Asso, Other , Long Beach, California
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