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Claims Administrator (Claims Adjuster) - Workers' Compensation
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Sacramento, CA Sacramento, California |
About this job
The Claims Administrator (Claims Adjuster) is responsible for the management of workers' compensation claims for assigned self-insured Affiliates. Individual must be able to manage claims from time reported until resolution. Must be able to work in a team environment with technical specialists, supervisor, claim manager and Affiliate representatives. Must also be able to partner with providers, SH Occ. Health, SH Risk Management to ensure integration of claim issues.
Duties include but are not limited to:
* Ensures the accurate, timely, and appropriate delivery of workers' compensation benefits in accordance with California laws.
* Assures and directs appropriate medical care and litigation management.
* Assures accurate and timely maintenance of reserving and excess reporting.
* Assures timely and thorough completion of diaries and file documentation.
* Supports THPM initiatives as assigned.
Keyword: Claims Adjuster, Claims Representative, Claims Examiner, Claims Analyst, Return to Work Coordinator.
Education:
HS Diploma required. BA/BS degree or equivalent combination of education and experience desired. Maintain current CEU requirements required. A Self-Insured Certificate and an Insurance Education Association Certificate desired.
Experience:
Must be able to demonstrate a thorough knowledge of California Workers' Compensation law. Computer literacy required.
Knowledge:
Significant prior claims payment/adjudication experience in workers' compensation is required. Proven oral and written communication skills is essential. Communications must reflect knowledge of grammar in English composition and acceptable business letter format, as well as, industry jargon. Demonstrated ability to handle confidential information is required. Experience with a claim payment system is desired. Knowledge of medical terminology, as well as, mathematical skills and a Self-Insurance Certification is preferred. Must ensure compliance with Best Practices and Policies and Procedures. Must have the ability to work independently, maintain a balance of work priorities and complete assignments within established timeframes.
Skills:
Example: Proficiency in spreadsheets using pivot tables, formulas and graphics
Special Requirements
Excellent analytical skills, the ability to draw valid conclusions, and formulate sound recommendations is required. Organizational and planning skills are required, as well as, the ability to manage and coordinate the activities related to the payment of workers' compensation claims. Ability to work with diverse health and administrative professionals at all organizational levels. Must be computer literate. Must have a working knowledge of WordPerfect 5.0 or greater, familiarity with Windows and a claim payment system preferred. Must be able to use a calculator, copy/fax machine, dictation equipment, as well as, other general office equipment. Organizational and planning skills are required, as well as, the ability to manage and coordinate the activities related to an assigned caseload. Valid drivers' license is required to ensure the ability to travel to client locations, WCAB hearings, rehabilitation conferences (formal and informal), professional development seminars, etc. Ability to communicate effectively both written and orally.
Duties include but are not limited to:
* Ensures the accurate, timely, and appropriate delivery of workers' compensation benefits in accordance with California laws.
* Assures and directs appropriate medical care and litigation management.
* Assures accurate and timely maintenance of reserving and excess reporting.
* Assures timely and thorough completion of diaries and file documentation.
* Supports THPM initiatives as assigned.
Keyword: Claims Adjuster, Claims Representative, Claims Examiner, Claims Analyst, Return to Work Coordinator.
Education:
HS Diploma required. BA/BS degree or equivalent combination of education and experience desired. Maintain current CEU requirements required. A Self-Insured Certificate and an Insurance Education Association Certificate desired.
Experience:
Must be able to demonstrate a thorough knowledge of California Workers' Compensation law. Computer literacy required.
Knowledge:
Significant prior claims payment/adjudication experience in workers' compensation is required. Proven oral and written communication skills is essential. Communications must reflect knowledge of grammar in English composition and acceptable business letter format, as well as, industry jargon. Demonstrated ability to handle confidential information is required. Experience with a claim payment system is desired. Knowledge of medical terminology, as well as, mathematical skills and a Self-Insurance Certification is preferred. Must ensure compliance with Best Practices and Policies and Procedures. Must have the ability to work independently, maintain a balance of work priorities and complete assignments within established timeframes.
Skills:
Example: Proficiency in spreadsheets using pivot tables, formulas and graphics
Special Requirements
Excellent analytical skills, the ability to draw valid conclusions, and formulate sound recommendations is required. Organizational and planning skills are required, as well as, the ability to manage and coordinate the activities related to the payment of workers' compensation claims. Ability to work with diverse health and administrative professionals at all organizational levels. Must be computer literate. Must have a working knowledge of WordPerfect 5.0 or greater, familiarity with Windows and a claim payment system preferred. Must be able to use a calculator, copy/fax machine, dictation equipment, as well as, other general office equipment. Organizational and planning skills are required, as well as, the ability to manage and coordinate the activities related to an assigned caseload. Valid drivers' license is required to ensure the ability to travel to client locations, WCAB hearings, rehabilitation conferences (formal and informal), professional development seminars, etc. Ability to communicate effectively both written and orally.
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