Claims Examiner - Long Beach, United States - Rose International

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    Description

    Date Posted: 05/09/2024

    Hiring Organization: Rose International

    Position Number:

    Job Title: Claims Examiner

    Job Location: Long Beach, CA, USA, 90806

    Work Model: Hybrid

    Employment Type: Temporary

    Estimated Duration (In months): 8

    Min Hourly Rate ($): 60.00

    Max Hourly Rate ($): 60.00

    Must Have Skills/Attributes: Claims, Document Review, Negotiation

    Job Description

    Only those lawfully authorized to work in the designated country associated with the position will be considered. **

    *Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client's business needs and requirements. *

    ***Only qualified Claims Examiner candidates located in the Long Beach, CA areas will be considered due to the position requiring an onsite presence*

    The client is seeking a qualified Claims Examiner to analyze mid- and higher-level workers compensation claims to determine benefits due, ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

    Required Experience:


    • 2 years plus Workers Compensation Claims experience

    Preferred Education/Certifications:


    • Prefer a college degree


    • Prefer SIP certificate

    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


    • 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

    Additional Functions and Responsibilities:


    • Performs other duties as assigned


    • Supports the organizations quality program(s)


    • Travels as required

    Benefits:

    For information and details on employment benefits offered with this position, please visit here. Should you have any questions/concerns, please contact our HR Department via our secure website.

    California Pay Equity:

    For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations website here.