Medical Claims Specialist - Workers Compensation

Location: San Diego, California; hybrid workplace

Salary: $26.4424 per hour

Company

A national insurance group providing insurance products across the United States, with a culture focused on relationships, integrity, collaboration, and inclusion.

What you will do

• Complete the Medical Claims Training Program and demonstrate mastery of medical claims adjusting fundamentals.
• Manage workers’ compensation medical-only claims from inception through resolution.
• Determine coverage, compensability, severity, reserves, and appropriate claim outcomes.
• Investigate claims, gather relevant information, issue required notices and filings, and ensure benefits comply with applicable law.
• Build working relationships with client contacts and collaborate with Call Center, Medical Management, Client Services, and indemnity Adjusting teams.

Requirements

• High school diploma or equivalent certificate.
• Ability to apply common-sense reasoning and follow written, oral, or diagram-based instructions.
• Ability to handle problems involving several concrete variables in standardized situations.
• Effective use of Microsoft Office Suite and ability to quickly learn proprietary and third-party software.
• Administrative experience in law, medicine, insurance, workers’ compensation, telephonic communication, or negotiation is useful but not required.

Culture & Benefits

• Manageable caseloads and work-life balance.
• Work From Home Program allowing up to two days per week from home.
• Free on-site fitness facility and garage parking.
• Paid time off, paid holidays, retirement savings match, and group medical, dental, and vision insurance.
• Life and AD&D insurance, long-term disability insurance, tuition reimbursement, employee assistance, and a paid community volunteer day.