- Investigate and assess the validity of workers' compensation claims by gathering information from various sources, including claimants, witnesses, medical records, and incident reports.
- Review and analyze policy coverage to ensure that the claimed injuries or illnesses are covered by the workers' compensation policy.
- Maintain regular communication with injured employees, employers, healthcare providers, and legal representatives to gather and provide information related to the claims process.
- Keep detailed and accurate records of all communications, actions taken, and decisions made during the claims process.
- Analyze medical documentation to evaluate the extent of injuries and determine appropriate compensation.
- Work closely with healthcare professionals to understand treatment plans, prognosis, and potential return-to-work timelines.
- Calculate and determine the appropriate compensation or benefits based on the nature and severity of the injuries, medical expenses, and other relevant factors.
- Engage in negotiations with claimants, legal representatives, and other involved parties to reach settlements in accordance with policy terms and legal requirements.
- Stay informed about relevant workers' compensation laws and regulations to ensure compliance with state and federal guidelines.
- Prepare and maintain documentation for legal proceedings, including hearings and appeals.
- Analyze claims data to identify trends, patterns, and areas for improvement in claims management processes.
- Prepare and submit regular reports to management and relevant stakeholders regarding the status of claims, financial reserves, and other key metrics.
- Provide excellent customer service to all parties involved in the claims process, addressing inquiries and concerns promptly and professionally.
- Coordinate with other departments such as risk management, legal, and finance to ensure a comprehensive and cohesive approach to claims resolution.
- Identify opportunities for process improvements and contribute to the development and implementation of best practices in claims management.
- Other duties as required.
- A bachelor's degree in a relevant field such as insurance, business administration, risk management, or a related discipline is often preferred.
- 5-7 years of experience in workers' compensation claims management
- Strong knowledge of workers' compensation laws, regulations, and industry practices is essential. Familiarity with other types of insurance and risk management is also beneficial.
- Excellent communication skills, both written and verbal, are important for interacting with claimants, employers, healthcare professionals, and legal representatives.
- Effective negotiation skills are essential for reaching fair and reasonable settlements with claimants and their legal representatives.
- The ability to manage multiple claims simultaneously, prioritize tasks, and meet deadlines is crucial.
- Familiarity with claims management software, databases, and other relevant tools.
- Must be bilingual Spanish and complete a Spanish assessment from company
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Senior Claims Rep Workers Compensation Bilingual Spanish- AR - California, United States - Ultimate Staffing
Description
Established organization is seeking a Bilingual Spanish Workers' Comp Claims Rep for direct hire Pay: $70-103k DOE
Requirements:
All qualified applicants will receive consideration for employment without regard torace, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status.We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.
