Imagine Staffing Technology

Compensation

Full Description

Job Profile Job Title: Claims Representative Location: Long Beach, CA Hire Type: Contingent Pay Range: $25 - $30/hr. Work Model: w/ SIP Remote/Onsite w/o SIP cert. Work Shift: Monday-Friday 8 am – 4:30 pm (37.50hrs. week) Recruiter Contact: Sean Craft I sean@marykraft.com I 443-345-3305 Nature & Scope: Positional Overview We are seeking an experienced Workers’ Compensation Claims Representative to handle medical-only and future medical claims. This role is responsible for processing lower-level workers’ compensation claims, determining benefits due, and ensuring adjudication aligns with company standards and industry best practices. The representative will also identify subrogation opportunities, negotiate settlements under general supervision, and maintain professional client relationships. Role & Responsibility: Tasks That Will Lead to Your Success • Process medical-only and low-level workers’ compensation claims, determining compensability and benefits due. • Monitor reserve accuracy and file necessary documentation with state agencies. • Develop and coordinate action plans for claim resolution and return-to-work efforts. • Approve claim payments and administer action plans pursuant to contracts. • Identify and pursue subrogation opportunities; negotiate settlements within authority. • Communicate claim actions and updates with claimants, clients, and providers. • Ensure claims are documented properly and coded accurately. • Handle low-level lifetime medical or defined-period medical claims, including state and physician filings and treatment reviews. • Maintain strong client relationships and provide responsive customer service. • Support organizational quality initiatives and perform other duties as assigned. Skills & Experience Qualifications That Will Help You Thrive • High School Diploma or GED required. • Bachelor’s degree from an accredited college or university preferred. • SIP certification preferred for remote eligibility within California. • Two (2) years of claims management experience, or equivalent combination of education and experience. • Successful completion of Claims Representative training accepted. • Knowledge of workers’ compensation regulations, offsets/deductions, disability duration, and medical management practices. • Familiarity with Social Security and Medicare application procedures a plus. • Strong oral and written communication skills. • Proficient in Microsoft Office Suite and related software. • Strong analytical, organizational, and interpretive abilities. • Ability to work both independently and collaboratively in a team environment. • Strong interpersonal and client service skills. • Ability to meet or exceed service expectations.