Remote Medical Coding Jobs in Rialto, CA (NOW HIRING)

• Responsible for analyzing, investigating, and managing complex workers' compensation claims through resolution.
• Handles claim exposure assessment, reserve management, litigation coordination, and benefit administration while ensuring compliance with applicable insurance laws and regulations.
• Collaborates with claimants, clients, vendors, and legal partners to deliver timely and cost-effective claim resolutions.

Requirement/Must Have:

• Strong experience managing workers' compensation claims.
• Knowledge of insurance principles, laws, and regulations related to workers' compensation claims.
• Experience handling claim investigations, litigation management, and settlement negotiations.
• Strong analytical and organizational skills.
• Excellent oral and written communication skills.
• Strong negotiation and interpersonal skills.
• Proficiency with Microsoft Office products and PC applications.
• Ability to work effectively in a team environment.
• Ability to meet or exceed service expectations.

Experience:

• Five years of claims management experience or equivalent combination of education and experience required.
• Experience managing claim reserves, recoveries, and benefit calculations.
• Experience coordinating with vendors, legal teams, and excess carriers.
• Experience handling Social Security and Medicare offsets preferred.

Responsibilities:

• Analyze and process complex workers' compensation claims.
• Investigate claims and gather information to determine claim exposure.
• Develop and manage claim action plans through resolution.
• Negotiate settlements within designated authority levels.
• Calculate and assign claim reserves and manage reserve adequacy.
• Calculate and process benefit payments and claim adjustments.
• Prepare and submit required state filings within statutory deadlines.
• Manage litigation activities and coordinate cost-effective claim resolution strategies.
• Coordinate vendor referrals for investigations and litigation support.
• Utilize cost containment and medical management practices to reduce claim costs.
• Manage claim recoveries including subrogation and offsets.
• Report claims to excess carriers and respond to requests in a timely manner.
• Communicate claim activity and updates with claimants and clients.
• Maintain accurate claim documentation and coding.
• Refer complex cases to supervisors and management when appropriate.
• Support organizational quality programs and additional assigned duties.
• Travel as required.

Should Have:

• Professional certification related to claims or insurance preferred.
• Experience with Social Security and Medicare application procedures preferred.
• Knowledge of disability duration and medical management practices preferred.

Skills:

• Workers' compensation claims management.
• Litigation and settlement negotiation.
• Reserve management and cost containment.
• Claim investigation and analysis.
• Insurance laws and compliance.
• Communication and client relationship management.
• Documentation and reporting.
• Microsoft Office proficiency.
• Problem-solving and organizational skills.

Qualification And Education:

• Bachelor’s degree from an accredited college or university preferred.
• Professional certification related to line of business preferred.