Workers Compensation Claims Examiner, Robert Half

Workers Compensation Claims Examiner

Robert Half

Location:

United States, Roseville

Category:

Insurance

Contract Type:

Employment contract, Contract work

Salary:

Not provided

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Job Description:

We are looking for a meticulous Workers Compensation Claims Examiner to join our team in Roseville, California. You will be handling and overseeing workers' compensation claims from start to finish, ensuring compliance with legal standards and our internal policies. Your role will require excellent communication skills, problem-solving abilities, and a comprehensive understanding of workers' compensation regulations.

Job Responsibility:

Analyze and process workers' compensation claims in a timely and efficient manner
Review medical records, accident reports, and other documentation to establish the validity of claims
Keep track of ongoing claims to ensure proper case management and resolution
Confirm that claims comply with regulatory guidelines and state-specific workers' compensation laws
Document claims, correspondence, and actions taken in detail
Communicate effectively with claimants, medical professionals, attorneys, and other stakeholders about claim status
Clearly explain workers’ compensation policies and procedures
Professionally address questions and concerns, ensuring a positive experience for all parties involved
Evaluate claim situations and make decisions about approvals, denials, settlements, or escalations based on evidence and policy
Negotiate settlements and authorize payments within set limits
Identify potential fraud or discrepancies within claims and report irregularities to the correct departments
Evaluate risks and recommend strategies for minimizing cases of non-compliance or overpayment
Collaborate with internal teams, including HR, legal, and finance departments
Keep up to date with changes in workers' compensation laws and guidelines
Participate in training programs to enhance claims management skills

Requirements:

Proficiency in Allscripts software is required
Must have experience with Cl Programming
Ability to use various computer programs effectively
Experience with handling appeals is necessary
Prior experience in auditing is essential
Understanding of benefit functions is crucial
Familiarity with billing functions is required
Must have experience in claim administration
Knowledge of Worker's Compensation is mandatory
Experience with workers compensation claims is necessary
Proficiency in handling insurance claims is required
Experience in claim adjudication is a must

What we offer:

medical
vision
dental
life and disability insurance
company 401(k) plan

Additional Information:

Job Posted:

March 24, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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