Sr.

Workers Compensation Examiner-4850 Claims - CA (Contract - Full Remote)Pleasant Hill, CA 94523Job Description

Sr.

Workers' Compensation Examiner-4850 Claims - CA (Contract - Full Remote) Pay Range $50.25 - $55.89 based on experience, skills, and location The Senior Claims Examiner will adjust workers' compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements.PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation.

Additional duties may be assigned: Establish contact with employer to review issues

Respond to inquiries from the employer, employee, doctors, and attorneys

Establish and maintain appropriate reserves

Review legal correspondence and medical reports

Evaluate and approve medical procedures and treatment

Administer advantages and ensure appropriateness of all payments

Investigate coverage, liability, and monetary value of claim

Review medical and legal bills for appropriateness

Discuss appropriateness of medical treatment with medical case manager

Determine compensability

Monitor and assist litigation

Negotiate settlement of claim, liens, rehabilitation plans, etc.

Prepare and present reports to clients

Appropriately close claims

Help resolve client billing and payment inquiries

Investigate complaints from injured workers





Document and code the claim files and claims system with all relevant information

Maintain and update action plans within specified time frames

Provide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasks

Contact with employers, employees, attorneys, doctors, vendors, and other parties

Provide customer service and support to clients and claimants

Work collaboratively with attorneys to draft settlements and assist with litigation strategies

Negotiate settlements

Authorize and negotiate cost of medical treatment and supplies

Internal communication with staff

Prepare professional, well written correspondence and other communicationsESSENTIAL POSITION REQUIREMENTS High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required Administrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtained Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section (f)



5+ years recent workers compensation claims handling experience required 3+ years' experience with 4850 Claims Solid knowledge of workers compensation laws, policies, and procedures' Completion of IEA or equivalent courses Proficiency in determining case value and negotiating settlements Understanding of medical and legal terminology Mathematical calculating skills Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution

Our clients operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data.

Therefore, maintaining honesty and integrity is essential for all roles within the company. ***JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more.

Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.***

📌 Sr. Workers Compensation Claims - CA (Contract - Full Remote) (Etobicoke)
🏢 JSG (Johnson Service Group
📍 Etobicoke