Workers Compensation Senior Claim Representative
Comptech Associates, Los Angeles, California, United States, 90079
Duration: 6 Months (Contract to Hire-CTH)
No. of Positions: 1
Job schedule-40 hours on site
Job hours-8:00-4:30
Interview process-WEBEX prescreen/Then in-person interview
Job Description Client is currently seeking a Workers’ Compensation Lost Time Senior Claim Examiner for our West Coast/Pacific region. The successful applicant will be handling claims from California. The position will report and reside in our Los Angeles, CA
Duties & Responsibilities
Handles all aspects of workers’ compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
Reviews claim and policy information to provide background for investigation.
Timely administration of statutory medical and indemnity benefits throughout the life of the claim.
Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.
Works with attorneys to manage hearings and litigation.
Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.
Files workers’ compensation forms and electronic data with states to ensure compliance with statutory regulations.
Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.
Works with in-house Technical Assistants, Special Investigators, Nurse Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.
Lost Time Claim Examiner position with prior experience in workers’ compensation as a lost time examiner.
Requires basic knowledge of workers’ compensation statutes, regulations, and compliance.
Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues.
Exceptional customer service and focus.
Ability to openly collaborate with leadership and peers to accomplish goals.
Demonstrates a commitment to a career in claims.
Experience, Education & Requirements
Experience working in a customer focused, fast-paced, fluid environment
Experience utilizing strong communication and telephonic skills
Prior experience requiring a high level of organization, follow-up, and accountability
Prior workers’ compensation claim handling experience or other similar type of claim handling experience is required (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, or general liability).
Prior insurance, legal or corporate business experience is a plus but not required
AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required
Proficiency with Microsoft Office Products
Knowledge of medical terminology is required
Knowledge of bill processing is required
Certification to handle CA Workers Compensation claims is required
Experience handling claims in the states of CO, UT, NV and AZ preferred
If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.
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No. of Positions: 1
Job schedule-40 hours on site
Job hours-8:00-4:30
Interview process-WEBEX prescreen/Then in-person interview
Job Description Client is currently seeking a Workers’ Compensation Lost Time Senior Claim Examiner for our West Coast/Pacific region. The successful applicant will be handling claims from California. The position will report and reside in our Los Angeles, CA
Duties & Responsibilities
Handles all aspects of workers’ compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
Reviews claim and policy information to provide background for investigation.
Timely administration of statutory medical and indemnity benefits throughout the life of the claim.
Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.
Works with attorneys to manage hearings and litigation.
Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.
Files workers’ compensation forms and electronic data with states to ensure compliance with statutory regulations.
Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.
Works with in-house Technical Assistants, Special Investigators, Nurse Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.
Lost Time Claim Examiner position with prior experience in workers’ compensation as a lost time examiner.
Requires basic knowledge of workers’ compensation statutes, regulations, and compliance.
Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues.
Exceptional customer service and focus.
Ability to openly collaborate with leadership and peers to accomplish goals.
Demonstrates a commitment to a career in claims.
Experience, Education & Requirements
Experience working in a customer focused, fast-paced, fluid environment
Experience utilizing strong communication and telephonic skills
Prior experience requiring a high level of organization, follow-up, and accountability
Prior workers’ compensation claim handling experience or other similar type of claim handling experience is required (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, or general liability).
Prior insurance, legal or corporate business experience is a plus but not required
AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required
Proficiency with Microsoft Office Products
Knowledge of medical terminology is required
Knowledge of bill processing is required
Certification to handle CA Workers Compensation claims is required
Experience handling claims in the states of CO, UT, NV and AZ preferred
If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.
#J-18808-Ljbffr