Top 83 Claims Representative Iii Jobs

Workers' Comp Claim Representative III - CA
Emergent Holdings —California
- $64,900 - $1,087,000 a year
- Full-time
- Bilingual
- Customer service
- 5 years
Bill Reviewer III
AvonRisk —Orange, CA
- $25 - $30 an hour
- Full-time
- Hybrid work
- Word processing
- Computer literacy
- Basic math
- Health savings account
- Paid holidays
Quick Apply
Clm Resltion Rep III, Hosp/Prv
University of Rochester —Albany, NY
- $20.30 - $27.41 an hour
- Full-time
- Remote
- Research
- Mid-level
- Associate's degree
Account Specialist III
Moove NA Distribution Holdings, Inc —Superior, WI
- From $40,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Computer literacy
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Claim Specialist II or III (NH & VT)
MEMIC —Remote
- $80,000 - $98,000 a year
- Remote
- Microsoft Word
- Research
- Mid-level
- Paid parental leave
- Health savings account
Claim Representative III - Property
Capital Insurance Group —San Jose, CA
- $77,406 - $129,010 a year
- Full-time
- Mid-level
- 3 years
- US work authorization
- Profit sharing
- Commuter assistance
Claims Representative III
West Bend Insurance Company —West Bend, WI
- $55,000 - $77,000 a year
- Full-time
- Hybrid work
- Mid-level
- Experience equivalent to degree accepted
- Associate's degree
- Health savings account
- Disability insurance
Commercial Auto Liability Claims Examiner III
TRISTAR RISK MANAGEMENT —Atlanta, GA
- $80,000 - $90,000 a year
- Full-time
- Remote
- Computer literacy
- Basic math
- High school diploma or GED
Quick Apply
Patient Account Specialist III - Santa Ana, CA
KPC GLOBAL MEDICAL CENTERS INC. —Santa Ana, CA
- $31.75 - $38.19 an hour
- Per diem
- Mid-level
- Team management
Quick Apply
Billing Representative III (A/R) - Boynton Beach, Florida
NYU Langone Health —Boynton Beach, FL
- Online Application
- Hospital
- Basic math
- English
- Wellness program
Claims Representative III
Berkley —Towson, MD
- $70,000 - $85,000 a year
- Full-time
- Analysis skills
- Travel
- Organizational skills
- Profit sharing
- Health insurance
Workers Compensation Claims Adjuster III (LAPD)
AvonRisk —Orange, CA
- $80,000 - $106,000 a year
- Full-time
- Hybrid work
- 5 years
- Conflict management
- Fair chance
- Health savings account
- Paid holidays
Quick Apply
Claim Specialist III
MEMIC —Pittsburgh, PA
- Remote
- Microsoft Word
- Driver's License
- Bachelor's degree
- Paid parental leave
- Health savings account
7d
Provider Service Representative III
L.A. Care Health Plan —Los Angeles, CA
- From $55,245 a year
- Weekends as needed
- HIPAA
- Mid-level
- High school diploma or GED
- Wellness program
- Health insurance
P&C Claim Representative III
Davies —Baltimore, MD
- $71,760 - $77,250 a year
- Email
- Background check
- Customer service
- High school diploma or GED
- Paid holidays
- Disability insurance
Quick Apply
Citizens - Adjuster III
Integrated Responders Group —Florida
- 8 years
- Senior level
- Communication skills
Customer Service Representative III
PeopleConnect —San Diego, CA
- $18.02 - $26.06 an hour
- Full-time
- Hybrid work
- Google Workspace
- Mid-level
- Office
- Paid parental leave
- Paid holidays
Quick Apply
10d
Customer Service Representative III
Stored Energy Systems —Longmont, CO
- $26 - $31 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Basic math
- Paid holidays
- Disability insurance
Quick Apply
Patient Billing/Services Representative III - Department of Medicine
Washington University in St Louis —St. Louis, MO
- $21.33 - $31.98 an hour
- Online Application
- Computer literacy
- BLS Certification
- Pass drug screening
- Commuter assistance
- Employee assistance program
Commercial Auto No Fault / PIP Claims Examiner III _ Temp
TRISTAR RISK MANAGEMENT —Philadelphia, PA
- $85,000 - $95,000 a year
- Temporary
- Remote
- Computer literacy
- Basic math
- Mid-level
Quick Apply

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Workers' Comp Claim Representative III - CA

Emergent Holdings -
California

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Job Details

Full-time
$64,900 - $1,087,000 a year

Qualifications

Customer communication
Workers' compensation insurance knowledge

Full Job Description

SUMMARY

This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May handle large, more complex customers requiring high touch, labor intensive claim service. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Mentors lower-level claim handlers. Coordinates special projects and provides guidance to others. Candidate must have California experience.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

Verifies workers’ compensation coverage of employers and injured employees.

Determines compensability under workers’ compensation by thorough investigation of the claim.

Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.

Facilitates return to work for the injured employee.

Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.

Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.

Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.

Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.

Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.

Works closely with manager on complex files or files above settlement/reserve authority.

Manages outside vendors to ensure cost containment efforts.

Establishes and maintains effective working relationships with all internal and external customers .

Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws.

Mentors team members.

Conducts audits of claim files.

Acts as a backup for team leader.

Coordinates special projects.

EDUCATION AND EXPERIENCE

Relevant combination of education and experience may be considered in lieu of degree.

Bachelor’s degree in a related field. Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

Five (5) years of experience in a workers’ compensation claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing complex workers’ compensation claims. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred.
- OR

Two (2) years of AF Group Claims Representative II experience that includes discretion in determining compensability of complex claims and/or handling complex, high touch or labor-intensive customers.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

OTHER SKILLS AND ABILITIES

Ability and proficiency in the use of computers and company standard software specific to position.

Knowledge of medical and legal terminology related to work.

Knowledge of workers’ compensation laws and regulations, including jurisdictional laws.

Effective oral and written communication skills.

Effective customer service skills.

Ability to negotiate, build consensus and resolve conflict.

Ability to manage multiple priorities and meet established deadlines.

Attention to detail and analytical skills.

Ability to work independently as well as within a team.

Ability to make independent decisions.

Ability to solve complex problems.

Ability to train and mentor others.

ADDITIONAL INFORMATION

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.

PAY RANGE:
Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $64,900 and $108,7000.

We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

#LI-CD1

#AFG

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Refine Your Search

Claims Representative Iii jobs

Workers' Comp Claim Representative III - CA

Bill Reviewer III

Clm Resltion Rep III, Hosp/Prv

Account Specialist III

Claim Specialist II or III (NH & VT)

Claim Representative III - Property

Claims Representative III

Commercial Auto Liability Claims Examiner III

Patient Account Specialist III - Santa Ana, CA

Billing Representative III (A/R) - Boynton Beach, Florida

Claims Representative III

Workers Compensation Claims Adjuster III (LAPD)

Claim Specialist III

Provider Service Representative III

P&C Claim Representative III

Citizens - Adjuster III

Customer Service Representative III

Customer Service Representative III

Patient Billing/Services Representative III - Department of Medicine

Commercial Auto No Fault / PIP Claims Examiner III _ Temp

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