Claims Processor I (Insurance)

Job Title: Claims Intake Specialist Location: Folsom, CA, 95630 Job Type: Full-time Based in Folsom CA with an office in Irvine CA, Samuel Hale is a data-driven entrepreneurial organization with a history of incubating new companies focused on Technology, Insurance, and Employment. Samuel Hale is truly unique and one of only 70 entities and municipalities granted the special designation by the State of California to resolve workers comp disputes directly with employees eliminating attorneys, fraudulent claims, and litigation costs. We enable our clients to “take back their business” in an environment where employment costs, HR compliance, and workers' compensation premiums have prevented California business owners from focusing on what they do best... running their companies. We value our people, and their personal and professional development, and we are committed to your growth because we want to see you thrive! You have an ambitious spirit and can manage to adapt to the changing demands of a fast-paced high-performance environment.

• You are motivated by innovation, growth, and opportunities to learn.
• You enjoy getting together with others to hash it out and find a creative solution to your and others' problems.
• We are seeking a highly motivated and detail-oriented Claims Intake Specialist to join our team. The ideal candidate will be responsible for managing the claims intake process, communicating with claimants, clients, adjusters, and claims oversight department, and ensuring compliance with the rules, regulations, and statutes of the ADR program and the State of California. Responsibilities: Own communication with claimants, clients, adjusters, and claims oversight department Monitor and respond to legal correspondence, emails, and calls within 24 hours on behalf of the employers File worker's compensation claims in ICE system and provide updates to claims management systems (CRM & ICE) Create an implementation of certain labor codes from the WCAB to the Alternative Dispute Resolution (ADR) program and ensure the codes are applied to current claims and enforced Manage open indemnity/MO claims daily including reviewing appropriate reserves, obtaining work status reports, informing employers of claimant's work status, and updating adjusters on any updates on behalf of the employer with the utmost of good faith in compliance with the rules, regulations, and statutes of the ADR program and the State of California Monitor medical treatment and ensure that employees are keeping their appointments and providing updated reports to in-house doctors and adjusters assigned Create bi-monthly claim reviews for over 100 clients and discuss the claims in detail, responding to any questions that may arise - Work with the clients in a team effort to support them with getting the employee back to work and lowering claim costs Correlate with the Fraud department to ensure fraudulent claims are reported to the correct parties and ensure timely denials Correlate with the Safety and Loss department to ensure all OSHA-violating claims are reported and inspected Correlate with the Underwriting department to ensure all class codes are up to date and out-of-state clients are in the system Requirements: Bachelor's degree in Business Administration, Insurance, or related field 5+ years of experience in claims management or related field Excellent communication and interpersonal skills Strong attention to detail and organizational skills Ability to work independently and in a team environment Proficient in Microsoft Office Suite Knowledge of workers' compensation laws and regulations in California Ability to multitask and prioritize workload Strong problem-solving skills If you are a highly motivated and detail-oriented individual with a passion for claims management, we encourage you to apply for this exciting opportunity. We are committed to diversity, providing equal opportunities, and hiring top talent.