Claims Examiner Workers Compensation at Adecco USA

Adecco is currently assisting a local client in their search to fill a Remote Claims Adjuster Workers Compensation job opportunity BUT MUST LIVE IN CALIFORNIA.

Pay rate: $

Shift: Mon – Fri 8am – 4:30pm PST

Length: 5 months

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.

 

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.

• 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).

• Travels as required.

 

Qualifications:           

• Bachelor's degree from an accredited college or university preferred.

• Min 3+ years as indemnity examiner handling CA Claims WC experience required.

• Experience Four (4) years of claims management experience or equivalent combination of education and experience 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 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

• 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

• Management retains the discretion to add or to change the duties of the position at any time.

Apply Today to be considered for this Remote Claims Adjuster Workers Compensation job and any other positions with Adecco.

Pay Details: $45.00 per hour

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

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The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance