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Claims Adjuster – Workers Compensation


This is a Full-time position in Sierra Madre, CA posted October 1, 2021.

Claims Adjuster – Workers Compensation

BCforward is currently seeking for a highly motivated Claims Adjuster – Workers Compensation Processor at Pasadena, CA 91107

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.

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.
Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
Manages subrogation of claims and negotiates settlements. Communicates claim action with claimant and client.
Ensures claim files are properly documented and claims coding is correct.
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. Maintains professional client relationships.

Performs other duties as assigned.
Supports the organization’s quality program(s).
Travels as required.

Education & Licensing
Bachelor’s degree from an accredited college or university preferred.

Four (4) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge
Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills Strong organizational skill
Good interpersonal skills Excellent negotiation skills Ability to work in a team environment
Ability to meet or exceed Service Expectations WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.
They are not intended to constitute a comprehensive list of functions, duties, or local variances.
Management retains the discretion to add or to change the duties of the position at any time.”

Must have minimum 3 years of California Indemnity Workers Compensation claims experience.
Self Insurance Plan certification preferred.
Candidate must reside in California.Training will be provided in Pasadena office for 2 weeks and then Telecommute is an option after completion of training.

High School Graduate/GED

Interested candidates please send resume in Word format Please reference job code 146783 when responding to this ad.