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

Job Description

Job Description... 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 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 Apply Job!