BC Forward is hiring for Claims Examiner - Workers Compensation at Las Vegas, NV
Position: Claims Adjuster - Workers Compensation
Location: Las Vegas, NV (Remote)
Duration: 3 Months
Job type: Contract with possible extension
Pay Rate: $35.00/hr. on W2
Job Description:
Manager's Note:
Work Location: Remote or onsite. Preference is for onsite; however, experienced candidates licensed in NV may be considered for remote work. NV license is mandatory.
PRIMARY PURPOSE:
Analyze mid- and higher-level workers’ compensation claims to determine benefits due, ensure ongoing adjudication aligns with company standards and industry best practices, and identify subrogation opportunities while negotiating settlements.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
- Manage workers’ compensation claims by determining compensability and benefits due on long-term indemnity claims. Monitor reserve accuracy and file required documentation with state agencies.
- Develop and manage claims action plans to resolution, coordinate return-to-work efforts, and approve claim payments.
- Approve and process assigned claims, determine benefits due, and manage action plans pursuant to the claim or client contract.
- Manage subrogation of claims and negotiate settlements.
- Communicate claim actions with claimants and clients.
- Ensure claim files are properly documented and claims coding is accurate.
- Process complex lifetime medical and/or defined-period medical claims, including state and physician filings, and decisions on appropriate treatments recommended by utilization review.
- Maintain professional client relationships.
ADDITIONAL FUNCTIONS AND RESPONSIBILITIES:
- Perform other duties as assigned.
- Support the organization’s quality programs.
- Travel as required.
QUALIFICATIONS:
Education & Licensing:
- Bachelor’s degree from an accredited college or university preferred.
- NV license required.
Experience:
- Four (4) years of claims management experience or an equivalent combination of education and experience.
Skills & Knowledge:
- Working knowledge of regulations, offsets and deductions, disability duration, medical management practices, and Social Security and Medicare application procedures as applicable to the line of business.
- Excellent oral and written communication skills, including presentation abilities.
- PC literate, including Microsoft Office products.
- Strong analytical and interpretive skills.
- Excellent organizational skills.
- Strong interpersonal skills.
- Excellent negotiation skills.
- Ability to work in a team environment.
- Ability to meet or exceed Service Expectations.
