Job Description
Please Find Below Job Details:
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Job Title: Claims Adjuster - Workers Compensation
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Job Location: El Dorado Hills, CA
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Job Duration: 3 Months
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Payrate: $36/hr. on W2
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PRIMARY PURPOSE:
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- 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.
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ESSENTIAL FUNCTIONS and RESPONSIBILITIES:
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- 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.
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ADDITIONAL FUNCTIONS and RESPONSIBILITIES
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- Performs other duties as assigned.
- Supports the organization's quality program(s).
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SKILLS & KNOWLEDGE:
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- 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
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