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Claims Adjuster
Career Insights for Claims Adjuster / Specialist (General)
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Scorecard
Based on California data
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What they do
A Claims Adjuster or Specialist investigates and evaluates insurance claims. Specializes in a particular type of insurance. Inspects property damage, including damage to homes, buildings and cars; reviews claims after they are submitted; may authorize or deny payment for claims. May work directly for insurers or on behalf of claimants.
$82,709 / year median in California
+7% projected growth
Job Description
Claims Adjuster at BayOne Solutions Claims Adjuster at BayOne Solutions in El Dorado Hills, California Posted in about 13 hours ago.
Type:
full-time
Please Find Below Job Details:
Job Title:
Claims Adjuster -
Workers Compensation Job Location:
El Dorado Hills, CA Job Duration:
3
Months Payrate:
$36/hr. on
W2 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.
ESSENTIAL
FUNCTIONS and
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. 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.
ADDITIONAL
FUNCTIONS and
RESPONSIBILITIES
Performs other duties as assigned. Supports the organization's quality program(s).
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