Lead Telecommunications Analyst
By Light Professional IT Services
CloudiOSUnityVoIP
Workers Compensation Claims Adjuster
Sedgwick
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $56,000 - $79,000 per year
Job Level
Mid-LevelSenior
About the role
- Analyze mid- and higher-level workers compensation claims to determine benefits due
- Ensure ongoing adjudication of claims within company standards and industry best practices
- Identify subrogation of claims and negotiate settlements
- Manage workers compensation claims determining compensability and benefits due on long term indemnity claims
- Monitor reserve accuracy and file necessary documentation with state agency
- Develop and manage workers compensation claims' action plans to resolution and coordinate return-to-work efforts
- Approve and process assigned claims and claim payments pursuant to the claim or client contract
- Manage subrogation of claims and negotiate settlements
- Communicate claim action with claimant and client and maintain professional client relationships
- Ensure 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
- Support the organization's quality program(s) and perform other duties as assigned
- Travel as required
Requirements
- Bachelor's degree from an accredited college or university preferred
- Four (4) years of claims management experience or equivalent combination of education and experience required
- California jurisdiction knowledge required
- SIP required within one year of employment
- 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
- Travel as required
