Workers Compensation Claims Adjuster
Imagine Staffing TechnologyOrange, CA, US3 days ago
Salary
$50.00 hourly
Job type
- Full-time
Job descriptionBachelor’s degree from an accredited college or university is preferred. Minimum of four (4) years of claims management experience, or an equivalent combination of education and experience. A minimum of 3 years of California workers’ compensation claims handling experience is required; candidates from outside CA must have 3 years of CA claims handling experience. SIP certification is preferred but not mandatory. Working knowledge of relevant regulations, offsets and deductions, disability duration, medical management practices, and Social Security / Medicare application procedures. Excellent oral and written communication skills, including strong presentation abilities. Proficiency in Microsoft Office products and a high level of computer literacy. Exceptional analytical, interpretive, and organizational skills with the ability to manage multiple priorities under tight deadlines. Strong interpersonal and negotiation skills; capable of working effectively in a team environment and meeting or exceeding service expectations.
Job Description
Job Description
Job Profile
Job Title
Workers Compensation Claims Adjuster
Location
Remote
Hire Type
Contingent
Hourly
Work Model
Monday – Friday
Contact Phone
443 ) -345-3305
Contact Email
Nature & Scope : Positional Overview
Mary Kraft is seeking an experienced Workers Compensation Claims to analyze mid- and higher-level workers’ compensation claims to determine benefits due, ensuring ongoing adjudication in line with company standards and industry best practices. This role is also responsible for identifying subrogation opportunities and negotiating settlements.
Role & Responsibilit y :
Tasks That Will Lead To Your Success
- Investigate and gather information to assess claim exposure, and develop well-structured action plans for timely resolution of complex or technically challenging workers’ compensation claims.
- Negotiate claim settlements within designated authority levels, ensuring that benefits are accurately calculated and paid.
- Calculate and assign timely, appropriate reserves to claims and continuously monitor reserve adequacy throughout the claim’s lifecycle.
- Prepare and submit necessary state filings within statutory limits; manage the litigation process to ensure cost-effective and timely claim resolution.
- Coordinate with vendors for additional investigations or litigation management, utilizing cost containment techniques and strategic vendor partnerships to reduce overall claim costs.
- Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security / Medicare offsets.
- Communicate claim activities and processes professionally with claimants and clients, maintain accurate documentation, and ensure proper claims coding.
- Refer cases to supervisors as appropriate and provide technical assistance as needed.
Skills & Experience :
Qualifications That Will Help You Thrive