Workers' Comp CA Licensed Claims Adjuster- Remote - Contract - CA

Job Description

Job Description...

Workers' Compensation CA Licensed Claims Adjuster, Senior ? Remote ? Contract - California

Fairbanks Claims Administration

$50/hour ? contract to permanent

Overview

Fairbanks Claims Administration is a high-deductible and self-insured workers? compensation TPA building a team of excellent adjusters.

Workers' Compensation Claims Adjuster, Senior

As a Workers' Compensation Claims Adjuster, Senior, you will be responsible for the investigation and adjustment of assigned claims.

Key Details
? Location: Remote
? Schedule: Monday to Friday, Contract to Permanent
? Types of Accounts: Light Industrial, other Miscellaneous
? Jurisdictions: California
? License Required: California Adjuster's License, do not apply if you do not have a license
? Preferred Certifications: SIP/WCCA/WCCP/AIC
? Computer Skills Required: Proficient in Microsoft Office
? Computer Skills Preferred: Proficient in ClaimPilot

Responsibilities
? Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
? Establish reserves and/or provide reserve recommendations within established reserve authority levels.
? Review, approve or provide oversight of medical and legal estimates and miscellaneous invoices to determine if reasonable and related to designated claims.
? Negotiate any disputed bills or invoices for resolution.
? Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
? Negotiate settlements in accordance with best practices, client specific handling instructions and state laws, when appropriate.
? Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
? Review and maintain personal diary on claim system.
? Assess and monitor subrogation claims for resolution.
? Prepare reports detailing claim status, payments and reserves, as requested.
? Provide notices of qualifying claims to excess/reinsurance carriers.
? Conduct claim reviews and/or training sessions for clients, as requested.
? Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
? Administer benefits on claims.
? Ensure timely utilization review (UR) processing.
? Process bills promptly.
? Communicate effectively with injured workers, clients, and attorneys.
? Maintain proper documentation of the claim file in a timely manner.
? Provide summary updates every 30, 60, or 90 days.
? Drive claims to resolution.
? Performs other duties as assigned.

Qualifications
? Excellent oral and written communication skills.
? Initiative to set and achieve performance goals.
? Good analytic and negotiation skills.
? Ability to cope with job pressures in a constantly changing environment.
? Knowledge of all lower level claim position responsibilities.
? Must be detail-oriented and a self-starter with strong organizational abilities.
? Ability to coordinate and prioritize required.
? Flexibility, accuracy, initiative and the ability to work with minimum supervision.
? Discretion and confidentiality required.
? Reliable, predictable attendance within client service hours for the performance of this position.
? Responsive to internal and external client needs.
? Ability to clearly communicate verbally and/or in writing, both internally and externally.

Performance
? Timely payment of benefits with no self-imposed penalties.
? Keeping diaries and mail up to date.
? Appropriately reserving files for the most probable outcome.

Education And/or Experience
? 5+ years of experience as a claims examiner handling semi-complex to complex-level claims.
? Strong analytical and problem-solving skills.
? Excellent communication and negotiation abilities.
? Ability to work independently and manage multiple priorities

Apply Job!