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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 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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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. Initiate the referral to the SIU of cases with suspected fraud.
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Review all medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file. 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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Assure that all assigned indemnity claims have an up to date plan of action outlining activities and actions anticipated for ultimately resolving the claim. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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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.
TemporaryRemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The Senior 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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Coordinates early return-to-work efforts with the appropriate parties. CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries.
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Schedule and or perform health assessments and evaluation of team members for return-to-work, fitness for duty, and medical surveillance in accordance with Pilgrim's health management, and safety protocols and the authorized physicians written directives.
ExpandApply NowActive JobUpdated 22 days ago - UpvoteDownvoteShare Job
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Oversees the court's workers' compensation, return-to-work and job accommodations programs. The incumbent is expected to work with the executive management team, other partner justice agencies and the Judicial Council of California to establish and maintain strong partnerships to meet court business, operating and judicial service requirements in a timely, efficient and high-quality manner.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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We are seeking a skilled Workers Compensation Claims Adjuster II. The ideal candidate will have a strong background in handling complex workers' compensation claims, demonstrating expertise in investigation, evaluation, negotiation, and settlement.
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Team Work - Supports everyone's efforts to succeed. Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Responds to requests for service and assistance; Meets commitments.
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workers complex return to work jobs
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