Workers' Comp CA Licensed Claims Adjuster- Remote - Contract - CA

Workers' Compensation CA Licensed Claims Adjuster, Senior – Remote – Contract - California

Fairbanks Claims Administration

$50/hour – contract to permanent

Overview

Fairbanks Claims Administration is a high-deductible and self-insured workers’ compensation TPA building a team of excellent adjusters.

Workers' Compensation Claims Adjuster, Senior

As a Workers' Compensation Claims Adjuster, Senior, you will be responsible for the investigation and adjustment of assigned claims.

Key Details:

• Location: Remote
• Schedule: Monday to Friday, Contract to Permanent
• Types of Accounts: Light Industrial, other Miscellaneous
• Jurisdictions: California
• License Required: California Adjuster's License, do not apply if you do not have a license
• Preferred Certifications: SIP/WCCA/WCCP/AIC

· Computer Skills Required: Proficient in Microsoft Office

· Computer Skills Preferred: Proficient in ClaimPilot

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Responsibilities:

• Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
• Establish reserves and/or provide reserve recommendations within established reserve authority levels.
• Review, approve or provide oversight of medical and legal estimates and miscellaneous invoices to determine if reasonable and related to designated claims.
• Negotiate any disputed bills or invoices for resolution.
• Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
• Negotiate settlements in accordance with best practices, client specific handling instructions and state laws, when appropriate.
• Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
• Review and maintain personal diary on claim system.
• Assess and monitor subrogation claims for resolution.
• Prepare reports detailing claim status, payments and reserves, as requested.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Conduct claim reviews and/or training sessions for clients, as requested.
• Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
• Administer benefits on claims.
• Ensure timely utilization review (UR) processing.
• Process bills promptly.
• Communicate effectively with injured workers, clients, and attorneys.
• Maintain proper documentation of the claim file in a timely manner.
• Provide summary updates every 30, 60, or 90 days.
• Drive claims to resolution.
• Performs other duties as assigned.

Qualifications:

• Excellent oral and written communication skills.
• Initiative to set and achieve performance goals.
• Good analytic and negotiation skills.
• Ability to cope with job pressures in a constantly changing environment.
• Knowledge of all lower level claim position responsibilities.
• Must be detail-oriented and a self-starter with strong organizational abilities.
• Ability to coordinate and prioritize required.
• Flexibility, accuracy, initiative and the ability to work with minimum supervision.
• Discretion and confidentiality required.
• Reliable, predictable attendance within client service hours for the performance of this position.
• Responsive to internal and external client needs.
• Ability to clearly communicate verbally and/or in writing, both internally and externally.

Performance:

• Timely payment of benefits with no self-imposed penalties.
• Keeping diaries and mail up to date.
• Appropriately reserving files for the most probable outcome.

Education and/or Experience:

• 5 years of experience as a claims examiner handling semi-complex to complex-level claims.
• Strong analytical and problem-solving skills.
• Excellent communication and negotiation abilities.
• Ability to work independently and manage multiple priorities.