Job Information
Robert Half Workers Comp Claims Examiner in Roseville, California
Description
We are looking for a meticulous Workers Compensation Claims Examiner to join our team in Roseville, California. You will be handling and overseeing workers' compensation claims from start to finish, ensuring compliance with legal standards and our internal policies. Your role will require excellent communication skills, problem-solving abilities, and a comprehensive understanding of workers' compensation regulations.
Responsibilities:
• Analyze and process workers' compensation claims in a timely and efficient manner.
• Review medical records, accident reports, and other documentation to establish the validity of claims.
• Keep track of ongoing claims to ensure proper case management and resolution.
• Confirm that claims comply with regulatory guidelines and state-specific workers' compensation laws.
• Document claims, correspondence, and actions taken in detail.
• Communicate effectively with claimants, medical professionals, attorneys, and other stakeholders about claim status.
• Clearly explain workers’ compensation policies and procedures.
• Professionally address questions and concerns, ensuring a positive experience for all parties involved.
• Evaluate claim situations and make decisions about approvals, denials, settlements, or escalations based on evidence and policy.
• Negotiate settlements and authorize payments within set limits.
• Identify potential fraud or discrepancies within claims and report irregularities to the correct departments.
• Evaluate risks and recommend strategies for minimizing cases of non-compliance or overpayment.
• Collaborate with internal teams, including HR, legal, and finance departments.
• Keep up to date with changes in workers' compensation laws and guidelines.
• Participate in training programs to enhance claims management skills.
Requirements • Proficiency in Allscripts software is required
• Must have experience with Cl Programming
• Ability to use various computer programs effectively
• Experience with handling appeals is necessary
• Prior experience in auditing is essential
• Understanding of benefit functions is crucial
• Familiarity with billing functions is required
• Must have experience in claim administration
• Knowledge of Worker's Compensation is mandatory
• Experience with workers compensation claims is necessary
• Proficiency in handling insurance claims is required
• Experience in claim adjudication is a must
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
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