Claims Associate - Workers Compensation

Claims Associate - Workers Compensation
Remote within CA
3 Months - Contract

Required Experience: WC, SIP preferred
Years of experience: minimum of 3 years.

PRIMARY PURPOSE:
To process low 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 with general supervision.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision. Supports other claims representatives, examiners and leads with larger or more complex claims as necessary. Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency. Communicates claim action/processing with claimant, client and appropriate medical contact. Ensures claim files are properly documented and claims coding is correct. May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims. Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.

QUALIFICATIONS
Education & Licensing
High school diploma or GED required. Licenses as required.

Experience
One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.

Skills & Knowledge
Excellent oral and written communication skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Ability to work in a team environment Ability to meet or exceed Performance Competencies

Education Level: High School Graduate/GED