What are the responsibilities and job description for the Senior Workers Compensation Claims Adjuster position at Questpro?
Insurance client located in California is seeing 3 Temporary Remote Sr Workers Compensation adjusters.
The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements.
Primary Responsibilities
The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
High School Diploma or equivalent (GED) required for all positions
Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f)
The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements.
Primary Responsibilities
- Establish contact with employer to review issues
- Respond to inquiries from the employer, employee, doctors, and attorneys
- Establish and maintain appropriate reserves
- Review legal correspondence and medical reports
- Evaluate and approve medical procedures and treatment
- Administer benefits and ensure appropriateness of all payments
- Investigate coverage, liability, and monetary value of claim
- Review medical and legal bills for appropriateness
- Discuss appropriateness of medical treatment with medical case manager
- Determine compensability
- Monitor and assist litigation
- Negotiate settlement of claim, liens, rehabilitation plans, etc.
- Prepare and present reports to clients
- Appropriately close claims
- Help resolve client billing and payment inquiries
- Investigate complaints from injured workers
- Document and code the claim files and claims system with all relevant information
- Maintain and update action plans within specified time frames
- Contact with employers, employees, attorneys, doctors, vendors, and other parties
- Provide customer service and support to clients and claimants
- Work collaboratively with attorneys to draft settlements and assist with litigation strategies
- Negotiate settlements
- Authorize and negotiate cost of medical treatment and supplies
- Internal communication with staff
- Prepare professional, well written correspondence and other communications
The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
High School Diploma or equivalent (GED) required for all positions
Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f)
- 3 years recent workers compensation claims handling experience required
- At least 5 years of workers compensation claims experience preferred
- Solid knowledge of workers compensation laws, policies, and procedures’
- Completion of IEA or equivalent courses
- Proficiency in determining case value and negotiating settlements
- Understanding of medical and legal terminology
- Mathematical calculating skills
- Proficient in Microsoft Office Suite