Date Posted: 11/01/2024
Hiring Organization: Rose International
Position Number: 473758
Job Title: Claims Adjuster
Job Location: Remote, USA
Work Model: Remote
Employment Type: Temporary
Estimated Duration (In months): 2
Min Hourly Rate($): 50.00
Max Hourly Rate($): 50.00
Must Have Skills/Attributes: Analytical Skills, Claims - Medical, Claims Processing, Microsoft Office, Negotiation
Nice To Have Skills/Attributes: SIP
Job Description
Claims Adjuster 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.
Preferred Education:
• Bachelor's degree from an accredited college or university preferred
Required Experience:
• Minimum of 3 years California (CA) claims handling experience is required
• 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
Preferred Experience, Knowledge and Location:
• Candidates located in California preferred
• SIP experience
Required Soft Skills:
• 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
Claims Adjuster Essential Functions and Responsibilities:
• Manages worker's 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
• Performs other duties as assigned
• Supports the organization's quality program(s)
• Travel 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.**
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.).
I believe the best thing that Rose HR has going for it is the incredible responsiveness. Everyone is very quick to reply to any concerns, and contacts the contracted employees very quickly and efficiently.
Kevin, Consultant
Rose International has been great to me. I thank everyone there for all of their hard work; it has not gone unnoticed.
Melody, Consultant
My on-boarding with Rose was outstanding. The packets of information, the process, and great attention to detail each person gave me allowed me to get started quickly.I appreciated each person's friendly and helpful attitude.
Diana, Consultant
I have been very pleased with my experience with Rose International. Everyone that I encountered was very helpful and courteous.
Stephanie, Consultant
Your team at Rose International is always very helpful and responsive.
Barbara, Consultant
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