Medical Only Claims Adjuster | California

Medical Only Workers' Compensation Claims Adjuster | 100% Remote Opportunity - California Must have experience in California General Summary Using claims system automation and capabilities, the Medical Only workers’ compensation Claims Adjuster is responsible for timely and accurate management of a high volume of workers’ compensation claims requiring minor or simple medical treatment and escalating them or moving them efficiently to closure. Essential Duties and Responsibilities

• Receives and reviews information related to new work comp insurance claims involving no or minimal lost time from work. Under direct supervision, may handle a small amount of fast-track indemnity claims that have low exposure or complexity.
• Communicates with injured workers, employers, and medical providers to obtain necessary additional information and evaluate claims for exceptions or escalations.
• Confirms or determines coverage and compensability as needed within state statutes and claims best practices.
• Reviews and responds to mail, emails, telephone calls and faxes from employers, providers, and injured workers within 24 hours.
• Reviews and responds to mail, emails, telephone calls and faxes from employers, providers and injured workers. Takes action to handle communication within established best practices and statutory requirements. Maintains ongoing professional communications with all internal and external customers.
• Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines. Files appropriate state forms, as needed.
• Manages or coordinates medical treatment and communicates with providers in a timely manner to continue to move the claim forward. Reviews medical bills and makes appropriate determinations.
• Reviews case facts to identify and report possible fraud or abuse throughout course of claim.
• Reviews claims for closure and proactively takes action to guide claims in that direction.

Requirements

• Minimum of 1 year general office experience or equivalent combination of education and experience.
• Excellent written and oral communication, customer service and telephone skills.
• Knowledge of MS Office software and an imaged environment.
• Demonstrated ability to understand and adhere to statutes, regulations and company policies and practices.
• Demonstrated skills in multi-tasking and prioritizing, adhering to deadlines and completing assignments.
• Conducts business at all times with the highest standards of personal, professional and ethical conduct. Ability to maintain confidentiality.
• Claims industry experience preferred.
• Working knowledge of medical or insurance terminology preferred.

Education:

• High school diploma or equivalent required.

Certification

• If State certification or license is required, must meet certification within

Work Environment:

• Remote: This role is a remote (work from home (WFH) opportunity, and only open to candidates currently located in the United States and able to work without sponsorship.
• It requires a suitable space that provides a private and quiet workplace.
• Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
• Travel: May be required to travel to off-site location(s) to attend meetings, as necessary

Salary Range: $20.00 - $26.00/hr and a comprehensive benefits package, please follow the link to our benefits page for details! https://www.employers.com/careers/our-benefits-and-perks/ About EMPLOYERS As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other! At EMPLOYERS, you’ll discover an energetic environment that inspires top achievement. As “America’s small business insurance specialist”, we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote Apply tot his job Apply To this Job