Top 5 Medical claims examiner Jobs in Oceanside, Ca

Workers' Compensation Claims Examiner
JT2 Integrated Resources —California
- From $90,000 a year
- Full-time
- Mid-level
- 3 years
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
Senior Workers Compensation Claims Examiner
Next Level Administrators, LLC —Murrieta, CA
- $95,000 - $110,000 a year
- Remote
- 5 years
- High school diploma or GED
- Analysis skills
- Commuter assistance
- Paid parental leave

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Workers' Compensation Claims Examiner

JT2 Integrated Resources -
California

Quick Apply

Job Details

Full-time
From $90,000 a year

Benefits

Health insurance
Dental insurance
401(k)
Flexible spending account
Paid time off
Vision insurance

Qualifications

Customer communication
Caseload management

Full Job Description

Claims Examiner - Workers Compensation, JT2 Integrated Resources

JT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients while providing quality care to claimants. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration with risk control solutions.

We are searching for a highly motivated Claims Examiner to join our team! Under supervision of the Claims Supervisor, the Claims Examiner will manage claims from inception to conclusion. The position requires an individual that adheres to best practices and State of California statutes to work directly with clients, injured workers, agents, vendors, and attorneys to resolve workers compensation claims.

Minimum Requirements

Three (3) years of claims management experience
Bachelor's degree from an accredited college or university preferred.
Possession of a current Self-Insurance Plan (SIP) Certificate and insurance-related course work: CPCU, WCCA, WCCP, ARM.
Must be able to administer any type of indemnity claim within the assigned caseload including those involving lost time, those likely to involve permanent disability residuals, and future medical claims.

Duties and Responsibilities

Ensure proper handling of claims from inception to conclusion per client service agreements and JT2 service standards.
Prepare accurate and timely issuance of benefits notices and required reports within statutory limits.
Reserve files in compliance with injury type, identify potential costs of medical care investigation and indemnity benefits.
Ensure timely payment of benefits, bills and appropriate caseload and performance goals.
Negotiate and prepare claims for settlement, provide manager/supervisor with complete and accurate settlement data.
Monitor, report, and assign claims for fraud potential and subrogation possibilities.
Monitor claims for pre-established criteria for case-management and vocational rehabilitation in accordance with State laws.
Prepare and present claims summaries to clients during file reviews.
Train and direct Claims Assistants to meet goals and deadlines.
Review and approve priority payments and other documents from Claims Assistants.
Performs other duties as assigned.

Knowledge, Skills, and Abilities

Strong knowledge of workers" compensation policy, concepts and terminology and benefit provisions.
Strong knowledge of adjusting workers" compensation claims for municipalities and administering LC 4850 benefits.
Strong skills with use of general office administration technology, including Microsoft Office Suite and related software.
Excellent verbal and written communication skills.
Excellent interpersonal and conflict resolution skills.
Excellent organizational skills and attention to detail.
Excellent interpersonal, negotiation, and conflict resolution skills.
Strong analytical and problem-solving skills.
Ability to act with integrity, professionalism, and confidentiality, at all times.
Remote work is acceptable.

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 to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

JT2 Integrated Resources provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Job Type: Full-time

Pay: From $90,000.00 per year

Benefits:

401(k)
Dental insurance
Flexible spending account
Health insurance
Paid time off
Vision insurance

Work Location: Remote

Quick Apply

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medical claims examiner jobs in oceanside, ca

Workers' Compensation Claims Examiner

Senior Workers Compensation Claims Examiner

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