NEW JOB OPENING
CLAIMS ADJUSTER - WORKERS COMPENSATION
IN Remote, USA!

***Only qualified workers' compensation candidates located in California may apply for this role***

Required Education:

• High School Graduate/GED

Preferred Education

• A bachelor’s degree from an accredited college or university is preferred.

Preferred License:

• OSIP license a plus



Required Experience

• Four (4) years of claims management experience or an equivalent combination of education and experience is required.



Skills & Knowledge

• Working knowledge of regulations, offsets and deductions, disability duration, medical management practices, and Social Security and Medicare application procedures 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

• Excellent negotiation skills

• Ability to work in a team environment

• Ability to meet or exceed Service Expectations



To analyze mid- and higher-level workers' compensation claims to determine benefits due, to ensure ongoing adjudication of claims within company standards and industry best practices, and to identify subrogation of claims and negotiate settlements.

Job Duties :

• 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.

• Manage subrogation of claims and negotiate settlements.

• Communicated 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 Job Duties:

• Performs other duties as assigned.

• Supports the organization’s quality program(s).

• Travels as required.

• **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.**