BCForward is looking for Claims Adjuster -Workers Compensation
Position Title: Claims Adjuster -Workers Compensation
Location: Orange, CA 92868
Anticipated Start Date: 10/21/2024
Expected Duration: 03 months
Shift: Monday - Friday, 8AM-5PM
Pay Range: $50.00
Job Title: Claims Adjuster -Workers Compensation
Job Summary:
We are seeking an experienced Workers Compensation Claims Adjuster with a minimum of 3 years of experience handling California claims. The ideal candidate will analyze mid- and higher-level workers compensation claims to determine benefits due, ensure claims are adjudicated in accordance with industry standards, and identify opportunities for subrogation and settlement negotiations. This role is remote, with a preference for candidates based in California.
**Primary Purpose:**
To manage, analyze, and resolve workers compensation claims efficiently while ensuring proper compensation and adherence to company standards and best practices. The role involves determining compensability, managing claim payments, negotiating settlements, and ensuring proper documentation and client communication.
**Essential Functions and Responsibilities:**
- **Claims Management:** Review and assess long-term indemnity workers compensation claims to determine compensability and benefits due, while ensuring compliance with state laws and company policies.
- **Claims Action Plans:** Develop and implement action plans for claim resolution, including coordinating return-to-work efforts and managing claims to ensure timely and accurate payments.
- **Subrogation and Settlement Negotiation:** Manage subrogation opportunities, negotiate settlements, and ensure that all necessary actions are taken to resolve claims in the best interest of the company and the claimant.
- **Documentation and Reporting:** Maintain accurate and detailed claim files, including proper coding and timely submission of required documentation to relevant state agencies.
- **Medical Claims Management:** Handle complex lifetime medical claims, including state and physician filings, and decisions regarding appropriate treatments as determined by utilization review.
- **Client Communication:** Provide regular updates and maintain professional relationships with clients regarding claim status and resolution efforts.
- **Quality Assurance:** Ensure all claims are processed according to company standards, including meeting service expectations and adhering to industry best practices.
- **Other Duties:** Perform other tasks as assigned to support the claims department and the organization's overall objectives.
**Additional Responsibilities:**
- Support the organization's quality program(s).
- Travel may be required for certain claims or client interactions.
**Qualifications:**
**Education and Licensing:**
- Bachelor's degree from an accredited college or university is preferred, but not required.
**Experience:**
- Minimum of 3 years of experience handling workers compensation claims in California required.
- A total of 4 years of claims management experience or equivalent combination of education and experience is required.
- SIP certification is preferred, but not mandatory.
**Skills & Knowledge:**
- Strong working knowledge of California workers compensation regulations, offsets, deductions, disability duration, medical management practices, and related procedures for Social Security and Medicare.
- Excellent oral and written communication skills, including the ability to present information clearly.
- Proficiency in Microsoft Office products and claims management software.
- Analytical skills to assess complex claims and make sound decisions.
- Strong organizational skills with the ability to manage multiple priorities.
- Excellent negotiation skills, particularly in settlement discussions.
- Ability to work effectively in a team environment and meet or exceed service expectations.
**Work Environment:**
- Remote work environment (California-based candidates preferred).
- Ability to handle mental and physical demands such as troubleshooting, problem-solving, multitasking, and meeting deadlines.
- Required to perform computer keyboarding and travel as needed.
BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
About BCforward: Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.
BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.
BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.
To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.
This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.
Interested candidates please send resume in Word format Please reference job code 231024 when responding to this ad.
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