Our client is seeking a skilled and detail-oriented Workers’ Compensation Claims Examiner to join their California team. This person will be responsible for handle moderate to complex California workers’ compensation claims, ensuring accurate processing and the management of benefits for medical care and billing, all while adhering to state regulations and company standards. This is a temp to perm role and this person will have the ability to work remotely.
Key Responsibilities:
- Review, investigate, and process workers’ compensation claims in accordance with California labor laws and company policies.
- Responsible for handling a caseload of 100 - 120 lost time California claims.
- Determine claim eligibility and compensability by gathering and analyzing required documentation, including medical records, accident reports, and employment details.
- Communicate with injured employees, medical providers, legal representatives, and employers to ensure proper claim resolution.
- Coordinate and authorize appropriate medical treatments, referrals, and payments while monitoring claim progress.
- Oversee medical billing processes to ensure accuracy and compliance with California workers' compensation fee schedules.
- Identify potential subrogation and manage settlement negotiations when applicable.
- Maintain accurate claim files and ensure compliance with all reporting requirements.
- Stay updated on California workers’ compensation laws, regulations, and best practices.
- Provide exceptional customer service to injured workers and stakeholders, addressing inquiries and concerns promptly.
Qualifications:
- 3 - 10+ years of experience as a Workers’ Compensation Claims Examiner, handling California claims.
- Thorough understanding of California workers’ compensation laws and regulations.
- Familiarity with medical terminology, treatments, and billing practices.
- SIP Certification required.
- Strong analytical and problem-solving skills with attention to detail.
- Excellent written and verbal communication skills.
Salary / Benefits:
- $40.00 to $50.00 per hour (depending on experience)
- Flexible remote work environment
- Comprehensive benefits package, including health, dental, and vision insurance
- Opportunities to convert to permanent employee
- Strong likelihood of converting to a permanent employee
