1 Position available at our Rocklin/Glendale/Fresno/Bellevue locations
Analyzes insurance claims to determine extent of insurance carrier's liability and settles claims with claimants in accordance with policy provisions by performing the following duties.
Essential Duties and Responsibilities
- Three-point contact, initial investigation, initial benefit determination.
- Ability to identify and address questionable (AOE/COE) claims.
- Establish and monitor reserves at periodic intervals.
- Prepare claims status report to carriers at 90-day intervals.
- Ability to manage and direct medical care, including strategies to maintain medical control and objection when appropriate.
- Identify and rate permanent disability.
- Vocational Rehabilitation file management.
- Negotiate and finalize claim settlements as well as lien settlements.
- Identify and manage subrogation issues on workers’ compensation claims.
- Work independently and in a fast paced environment.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
3 years of experience as a Workers’ Compensation Claims Assistant, or up to one year Trainee or Future Med Adjuster experience; or Bachelor’s degree (B.A.) and six months experience.
Certificates and Licenses
Insurance Education Certificate of Completion for the core courses.