Claims Adjuster at Rose International
Remote, OR 99999
About the Job
JOB RESPONSIBILITIES
•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
•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.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
•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.**
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.).
