Date Posted: 09/13/2023
Hiring Organization: Rose International
Position Number: 450038
Job Title: Claims Adjuster - Workers Compensation
Job Location: Remote, USA
Employment Type: Temp to Hire
Min Hourly Rate($): 36.00
Max Hourly Rate($): 37.00
Must Have Skills/Attributes: Claims, Communications, Compensation, Technical
Job Description
- **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.**
Description:
Candidate must be in California
PRIMARY PURPOSE:
• To analyze mid- and higher-level worker’s 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 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 worker’s 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.
Mental:
• Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical:
• Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking
NOTE:
• Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.
• They are not intended to constitute a comprehensive list of functions, duties, or local variances.
• Management retains the discretion to add or to change the duties of the position at any time.
• Requirements: SIP a plus- Must be in California
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 am very happy with the Rose International, and the professionalism of the employees.
Robin, Consultant
It is a great pleasure being a part of the Rose International Team.
Toni, Consultant
As a contractor, I have to say that Rose International was by far the best agency I have worked for.
Q'testdalir, Consultant
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
Any time I did have a question and called, the phone was always answered, and my question/concern was immediately resolved.
Sally, Consultant
EMPLOYEE COMMENTS