Looking for Sr. Claims Specialist - Workers Compensation (Remote in CA)

Notes:

• Remote in CA - Candidate has to be physically located in CA.
• Temp to perm possibility.
• SIP is nice to have but not required
• Years of experience required: 5+
• Public agency & self-insured account experience is desirable.

Primary Purpose:

To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

Responsibilities

• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Experience Four (5+) years of claims management experience or equivalent combination of education and experience required.