Remote Insurance Claims Jobs in Encinitas, CA (NOW HIRING)

Recruiters & Staffers - We prefer to hire direct. Please do not solicit your services to any member of our organization. 
Interested Applicants - The hiring team for this position will handle all applicants and communications through our Applicant Tracking System. Resumes emailed direct to other members of our company will not be considered. 
Description

The Claims Manager is a fully remote role responsible for serving as a liaison for clients in the management of Workers’ Compensation claims. On behalf of the client, you will communicate (through phone and email as necessary) with doctors, insurance adjusters, and workers ' comp attorneys in order to use our process and strategies to get the best results for clients on each claim. You will also provide strategy and status updates to clients following our process, in quarterly reports, and upon their request.

The Claims Manager will also analyze patterns and trends in a client's claims history to ensure that our strategies are adjusted as necessary and continue to produce the highest level of results.

This role will: 

• Educate Clients on Claims Management Procedures
• Coordinate Claims Strategy with Clients, Adjusters, Attorneys, and Doctors
• Analyze Claims & Financial data to provide a summary and strategy to clients

Please Note: At this time, we are not accepting unsolicited contact from recruiters, staffing agencies, or headhunters. We respectfully request that third parties refrain from reaching out regarding this position. Our hiring team is focused on sourcing and engaging directly with candidates, and we prefer to manage our recruitment efforts internally. Thank you for your understanding.

• Provide exceptional customer service by delivering proactive, thoughtful, and professional communication to clients, ensuring their expectations for high-level service are consistently met.
• Communicate effectively with all parties involved in insurance claims, including adjusters, attorneys, and medical professionals, to ensure accurate and timely updates while advocating for the best outcomes for clients.
• Use strong negotiation and problem-solving skills to tactfully redirect claims processes when necessary, aligning them with the client’s best interests.
• Analyze client claims data and overall claim histories to identify patterns, trends, and optimal strategies, leveraging basic mathematical and analytical skills to support decision-making.
• Clearly explain claims strategies to clients, demonstrating an understanding of underlying concepts and calculations.
• Utilize Salesforce and other tools to manage claims efficiently, access and analyze claims data, and generate reports as needed.
• Perform day-to-day tasks using Microsoft Word, Excel, Outlook, Adobe, and other Microsoft Office applications, ensuring accuracy and efficiency in all computer-related activities.

Customer Service skills. Clients are used to a very high level of service, and we need the clients to receive proactive and thoughtful communication from our team. 

Strong communication skills. Sometimes the job is as simple as relaying information at the right time, following our process, or making a simple status request from an insurance adjuster so we're up to date on a claim. In some instances, the other parties involved in a claim (doctors, adjusters, attorneys, etc) may try to steer the claim in a direction that isn't the best for clients. You'll need to be able to tactfully direct the claim back into the best interest of the client. Training will be provided on when to do this, and tips can be provided on how, but strong communication/negotiation skills will be very useful.

Basic Mathematical & Analytical skills. We review clients' claims data to determine what strategy is best for each claim. We also review their overall claim history to determine patterns and trends and continue to deliver better results. Our system will do most of the math for you, but you'll need to understand the concepts behind the calculations in order to explain our strategy to clients.

Basic Computer skills. We manage claims through Salesforce. You'll access a number of websites to gather claims data. You'll also use Microsoft Word, Adobe, PDFs, Outlook, and other Microsoft Office apps.

We are a modern commercial insurance agency with a very unique platform of services that helps businesses that struggle with workers ' compensation injuries. We've spent the last ten years honing our niche and developing a highly unique product that drives unrivaled results for clients.

We solve challenges that business owners typically don't even know exist until they meet us. It makes it difficult to get our foot in the door - but once we have the opportunity to educate them on Workers' Comp and how our platform resolves a number of common problems with their insurance, most of them wish they'd heard of this much sooner!

Employee Benefits:

• Competitive Compensation
• Monthly Health & Wellness Credit
• Employer-Sponsored Health Care Plan
• Retirement Plan with a 5% match
• Flexible Paid Time Off
• Training & Development Support

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