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The CA Workers Compensation Sr. Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel.
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Form a partnership with the medical case manager to maximize early return to work potential thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs.
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Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them. Requires a high degree of claims handling expertise to include a minimum of at least five years experience managing indemnity cases, many with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues & possess an SIP certificate.
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Initiate the referral to the SIU of cases with suspected fraud. Review all medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file.
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Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments. Title: Claims Adjuster - Workers Compensation (Hourly) (1309922.
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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.
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Handle moderate to complex workers compensation claims with minimal supervision and guidance from the manager. This role will consist of handling moderate to complex Arizona Workers Compensation Lost Time claims from inception to close.
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Thoroughly and accurately document ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and what is being done to move the case toward closure.
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Reports directly to the unit Claims Supervisor and may be called upon to provide technical backup in the absence of the Claims Supervisor. In accordance with applicable statutes and in keeping with company rules, regulations, and established performance objectives, is responsible for effectively managing to conclusion an assigned inventory of claim files that may include cases of extreme complexity or with unique or unusual issues.
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Team Work - Supports everyone's efforts to succeed. Assure that all assigned indemnity claims have an up to date plan of action outlining activities and actions anticipated for ultimately resolving the claim.
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The Experienced Claims Examiner is responsible for the management of a complex caseload of workers compensation indemnity claims from inception to resolution. Helps injured workers achieve rapid and full medical recovery and early, safe return to work through effective, efficient and timely medical treatment and return-to-work support.
$77,670 - $102,100 a yearFull-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Active study for the IEA Certificate and Self-Insured Certificate, and successful completion of, or active study for the WCCP designation, or the equivalent in related studies or work experience.
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Perform a three-point contact on all new losses within 24 hours of receipt of the claim to include the claimant, employer, and treating physician to document relevant facts surrounding the incident itself as well as disability and treatment status.
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To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt.
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Litigation management - Direct, manage, and control the litigation process. Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.
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workers compensation complex return to work jobs
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