- 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.
- 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
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
-
Claims Adjuster
1 week ago
TAJ Technologies Inc Long Beach, United States: · Remote - Candidate has to be in CA. · Min 5 years of CA claims handling experience is mandatory. · SIP is preferred. · PRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within c ...
-
Sr Adjuster, Claims
1 week ago
Molina Healthcare Long Beach, United States**Job Description** · **Job Summary** · Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims. Ensures that claims a ...
-
Workers Compensation Claims Adjuster
3 weeks ago
Sedgwick Claims Management Services Long Beach, United StatesTo 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. ES Workers Compensation, Claims, ...
-
Claims Adjuster
2 weeks ago
Sunrise Systems Los Angeles, United StatesJob Title: Claims Adjuster - Lost Time · Location: Los Angeles, CA 90071 · Duration: 6+ months contract to begin with · Position Type: Hourly contract Position (W2 only) · Job Description: · Note: Job Schedule-Hybrid-3 days in office Tuesday/Wed/Thursday, Flexible upon performanc ...
-
Claims Adjuster
3 weeks ago
Experis Los Angeles, United States ContractJoin Our Team: Claims Adjuster - Workers Compensation · Location: Los Angeles CA · Pay Range: $42-48/hr · What's the Job? · The main function of a Workers' Compensation Claims Adjuster is to investigate, analyse, and determine the extent of insurance company's responsibility for ...
-
Claims Adjuster
2 days ago
Comptech Associates Los Angeles, United StatesAbout the Job: · Job Title: Claims Adjuster - Workers Compensation · Duration: 3+ Months (CTH) · Location: Los Angeles, CA · Job schedule-40 hours on site · Job hours-8:00-4:30 · Interview process-WEBEX prescreen/Then in-person interview · Summary: The main function of a Workers' ...
-
Claims Adjuster
1 week ago
Kaiser Permanente Downey, United States: Job Summary: · Reviews claims and makes payment and benefit determination. Conducts research as it relates to claims processing for medical appropriateness, and diagnosis, using ICD-9 codes and CPT codes as required. · Essential Responsibilities: · Reviews claims and makes paym ...
-
Claims Adjuster
1 week ago
Knight Management Insurance Services Los Angeles, United StatesRemote / Claims · Pay Range: $60,000-$70,000 Per Year. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire and will be dependent on a wide range of factors, including but not limited to geographic location, skill set, ex ...
-
Claims Adjuster
1 week ago
Hankey Group External Los Angeles, United StatesRemote / Claims · Pay Range: $60,000-$70,000 Per Year. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire and will be dependent on a wide range of factors, including but not limited to geographic location, skill set, ex ...
-
Claims Adjuster
1 week ago
Georgia IT Inc Los Angeles, United StatesClaims Adjuster - Workers Compensation · Location: Los Angeles, CA. Hybrid-3 days in office Tuesday/Wed/Thursday , Flexible upon performance. Job Hours-8:00 am-4:30 am · Duration: 6 months · Job description · Summary: · The main function of a Claims Adjuster is to investig ...
-
Claims Adjuster
6 days ago
Experis Los Angeles, United StatesJoin Our Team: Claims Adjuster - Workers Compensation · Location: Los Angeles CA · Pay Range: $42-48/hr · What's the Job? · The main function of a Workers' Compensation Claims Adjuster is to investigate, analyse, and determine the extent of insurance company's responsibility ...
-
Claims Adjuster
1 week ago
Manpower Group Inc. Los Angeles, United StatesJoin Our Team: Claims Adjuster - Workers Compensation · Location: Los Angeles CA · Pay Range: $42-48/hr · Whats the Job? · The main function of a Workers' Compensation Claims Adjuster is to investigate, analyse, and determine the extent of insurance company's responsibility f ...
-
Claims Adjuster
4 days ago
Progressive Insurance Santa Monica, United StatesJoin Forbes' 2024 Best Employer for Diversity · As an auto damage claims adjuster, you'll serve as Progressive's point of contact with customers - directing and making decisions regarding the repair process from beginning to end.Managing your own inventory while working independ ...
-
Claims Adjuster
3 hours ago
Comptech Associates Los Angeles, United StatesJob Title: Claims Adjuster - Workers Compensation · Duration: 3+ Months (CTH) · Location: Los Angeles, CA · No. of Positions: 2 · Job schedule: Hybrid (3 Days Onsite/2 Days Remote) · Job hours-8:00-4:30 · Interview process-WEBEX prescreen/Then in-person interview · Summary: The m ...
-
Elite Long Beach, United StatesJob Description · Job DescriptionThis position will be a remote position. · Must have a California SIP (Workers Compensation - Sr. Work Comp Claims Adjuster) · POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusi ...
-
Claims Adjuster
1 week ago
Insight Global Irvine, United StatesReceives claims, confirms policy coverage and acknowledgment of the claim · - Determines validity and compensability of the claim · - Establishes reserves and authorizes payments within reserving authority limits · - Manages non-complex and non-problematic medical only claims and ...
-
Workers Compensation Claims Adjuster
2 weeks ago
Sedgwick Long Beach, United StatesTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
-
Property Claims Adjuster
2 weeks ago
Tokio Marine Highland South Pasadena, United StatesWe are Precise Adjustments, Inc. - a full-service claims administration and adjustment company. We are a wholly owned company of Tokio Marine Highland, a leading property and casualty underwriting agency and a subsidiary of Tokio Marine Kiln, one of the largest carriers in the Ll ...
-
Claims Adjuster/Claim Examiner
3 weeks ago
DB Insurance Anaheim, United StatesCompany and Position Overview · DB Insurance Co Ltd (US Branch) is looking for a full-time LIABILITY CLAIMS ADJUSTER/EXAMINER who has experience handling Commercial General Liability/Auto BI Liability claims. · About DB Insurance · DB Insurance Co., Ltd. Is one of the largest ...
-
Claims Adjuster/Claim Examiner
1 week ago
DB Insurance Anaheim, United StatesCompany and Position Overview · DB Insurance Co Ltd (US Branch) is looking for a full-time LIABILITY CLAIMS ADJUSTER/EXAMINER who has experience handling Commercial General Liability/Auto BI Liability claims. · About DB Insurance · DB Insurance Co., Ltd. Is one of the largest ...
Workers Compensation Claims Adjuster - Long Beach, United States - Sedgwick
Description
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work
Most Loved Workplace
Forbes Best-in-State Employer
Workers Compensation Claims Adjuster | Long Beach or Roseville, CA
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.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Education & Licensing
Bachelor's degree from an accredited college or university preferred.
Experience
Four (4) years of claims management experience or equivalent combination of education and experience required.
Skills & Knowledge
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: 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
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $55,000 - $99,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
#Claims #Claimsadjuster
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.