Priority Claims Specialist III
Hanger, Inc.
Workers Compensation Claims Adjuster
Sedgwick
full-time
Posted on:
Location: California • 🇺🇸 United States
Visit company websiteSalary
💰 $60,000 - $72,000 per year
Job Level
Mid-LevelSenior
About the role
- 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.\n
- ESSENTIAL FUNCTIONS and RESPONSIBILITIES Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.\n
- Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.\n
- Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.\n
- Manages subrogation of claims and negotiates settlements.\n
- Communicates claim action with claimant and client.\n
- Ensures claim files are properly documented and claims coding is correct.\n
- 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.\n
- Maintains professional client relationships.\n
- ADDITIONAL FUNCTIONS and RESPONSIBILITIES\n
- Performs other duties as assigned.\n
- Supports the organization's quality program(s).\n
- Travels as required.\n
- QUALIFICATIONS\n
- Education & Licensing Bachelor's degree from an accredited college or university preferred.\n
- Experience Four (4) years of claims management experience or equivalent combination of education and experience required.\n
- 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\n
- Excellent oral and written communication, including presentation skills\n
- PC literate, including Microsoft Office products\n
- Analytical and interpretive skills\n
- Strong organizational skill\n
- Good interpersonal skills\n
- Excellent negotiation skills\n
- Ability to work in a team environment\n
- Ability to meet or exceed Service Expectations
Requirements
- Bachelor's degree from an accredited college or university preferred\n
- Four (4) years of claims management experience or equivalent combination of education and experience required\n
- 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\n
- Excellent oral and written communication, including presentation skills\n
- PC literate, including Microsoft Office products\n
- Analytical and interpretive skills\n
- Strong organizational skill\n
- Good interpersonal skills\n
- Excellent negotiation skills\n
- Ability to work in a team environment\n
- Ability to meet or exceed Service Expectations
