Date Posted: 10/29/2024
Hiring Organization: Rose International
Position Number: 473585
Job Title: Claims Adjuster
Job Location: Remote, USA
Work Model: Remote
Employment Type: Temp to Hire
Estimated Duration (In Weeks): 7
Min Hourly Rate($): 46.42
Max Hourly Rate($): 46.42
Must Have Skills/Attributes: Analytical Skills, Claims, Computer Literacy, Medicare, Microsoft Office, SIP
Job Description
Primary Purpose:
• 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.
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.
Qualifications
• Education & Licensing Bachelor''s degree from an accredited college or university preferred. Experience Four (4) years of claims management experience or equivalent combination of education and experience required.
• Skills & Knowledge Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure 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 skill Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations
Work Environment
• When applicable and appropriate, consideration will be given to reasonable accommodations.
Requirements:
• Min 3 Years of CA claims handling experience required.
• Remote in CA preferred. If candidate is from other state, 3 years of CA Claims handling experience is must.
• SIP is preferred not mandatory. - **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.**
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.
Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.
If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department.
Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).
Working for Rose International was the most pleasant assignment I have ever had. They were always on top of situations when necessary, and very helpful. I was very proud to be an employee of Rose International, and would recommend anyone to try to work with them.
Melvon, Consultant
I am very happy with the Rose International, and the professionalism of the employees.
Robin, Consultant
I have been very pleased with my experience with Rose International. Everyone that I encountered was very helpful and courteous.
Stephanie, Consultant
I had a very positive experience working for Rose. The entire process is very efficient and easy.
Joanne, Consultant
You are customer service oriented. No matter whether it was the Recruiter or someone in Human Resources/Payroll, you were responsive. That to me is key!
Tonya, Consultant
EMPLOYEE COMMENTS