Sr. Workers Compensation Claims - CA (Contract - Full Remote)

Sr. Workers Compensation Examiner-4850 Claims - CA (Contract - Full Remote)Pleasant Hill, CA 94523Job DescriptionSr. Workers' Compensation Examiner-4850 Claims - CA (Contract - Full Remote) Pay Range $50.25 - $55.89 based on experience, skills, and location The Senior Claims Examiner will adjust workers' compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements.PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:Establish contact with employer to review issuesRespond to inquiries from the employer, employee, doctors, and attorneysEstablish and maintain appropriate reservesReview legal correspondence and medical reportsEvaluate and approve medical procedures and treatmentAdminister benefits and ensure appropriateness of all paymentsInvestigate coverage, liability, and monetary value of claimReview medical and legal bills for appropriatenessDiscuss appropriateness of medical treatment with medical case managerDetermine compensabilityMonitor and assist litigationNegotiate settlement of claim, liens, rehabilitation plans, etc.Prepare and present reports to clientsAppropriately close claimsHelp resolve client billing and payment inquiriesInvestigate complaints from injured workersDocument and code the claim files and claims system with all relevant informationMaintain and update action plans within specified time framesProvide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasksContact with employers, employees, attorneys, doctors, vendors, and other partiesProvide customer service and support to clients and claimantsWork collaboratively with attorneys to draft settlements and assist with litigation strategiesNegotiate settlementsAuthorize and negotiate cost of medical treatment and suppliesInternal communication with staffPrepare professional, well written correspondence and other communicationsESSENTIAL POSITION REQUIREMENTS High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required Administrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtained Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section (f) 5+ years recent workers compensation claims handling experience required 3+ years' experience with 4850 Claims Solid knowledge of workers compensation laws, policies, and procedures' Completion of IEA or equivalent courses Proficiency in determining case value and negotiating settlements Understanding of medical and legal terminology Mathematical calculating skills Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolutionOur clients operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. ***JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.***