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Remote Claims Examiner - Workers Compensation Asso

Company: AppleOne
Location: Long Beach
Posted on: May 14, 2022

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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