Insurance Claims Specialist - Workers' Compensation - Ultimate Staffing Services

Direct Hire

$90k-$95k (DOE)

Job Summary: We are seeking a detail-oriented and experienced Claims Specialist with a strong background in workers' compensation to manage and process claims efficiently and accurately. The ideal candidate will have a deep understanding of workers' compensation laws, regulations, and best practices. As a Claims Specialist, you will be responsible for evaluating claims, ensuring compliance, communicating with stakeholders, and providing excellent customer service to all parties involved.

Key Responsibilities:

• Review, evaluate, and process workers' compensation claims from initial filing through resolution.
• Investigate claims by gathering relevant information, including medical records, reports, and statements, to determine liability and eligibility.
• Ensure all claims are handled in compliance with state and federal workers' compensation laws, policies, and guidelines.
• Communicate with injured workers, healthcare providers, employers, and attorneys to gather information and provide status updates on claims.
• Coordinate medical treatments and case management with medical providers to ensure timely and appropriate care for injured workers.
• Calculate and process benefit payments, including wage loss, medical expenses, and rehabilitation benefits.
• Maintain accurate and up-to-date records for each claim in the claims management system.
• Work with adjusters, legal teams, and other stakeholders to resolve disputes and negotiate settlements when necessary.
• Monitor claims for trends and ensure timely closure of claims, identifying opportunities for process improvements.
• Provide support and guidance to clients and stakeholders on workers' compensation claims procedures and legal requirements.
• Prepare reports on claim status, trends, and performance metrics for management review.
• Handle claims escalations and ensure timely resolution of complex or high-priority claims.

Qualifications:

• Proven experience as a Claims Specialist with a focus on workers' compensation claims.
• In-depth knowledge of workers' compensation laws, regulations, and industry standards.
• Strong analytical and investigative skills to assess claims and determine appropriate actions.
• Excellent communication and interpersonal skills, with the ability to work effectively with diverse stakeholders.
• Strong organizational and time-management skills, with the ability to manage multiple claims and priorities.
• Proficiency with claims management software and MS Office Suite.
• Ability to maintain confidentiality and handle sensitive information with discretion.
• Attention to detail and accuracy in processing claims and maintaining records.
• Certification in Workers' Compensation (preferred but not required).
• A Bachelor's degree

  All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county, to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.