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Claims Examiner Workers Compensation

Apidel Technologies

Remote • 6d ago

Easy Apply

Contract

Workers' Compensation Lost Time Adjuster (Remote)

Davies

Remote or Birmingham, Alabama • Today

Full-time

USD 70,000.00 - 75,000.00 per year

FACETS Architect (with Healthcare Claims)

Mindlance

Remote • Today

Easy Apply

Contract

$80 - $90

Senior Project Manager(Healthcare Claims Experience(Required))

eSystems, Inc.

Remote • 7d ago

Easy Apply

Contract, Third Party

55 - 65

Claims Specialist

Pyramid Consulting, Inc.

Remote • Today

Easy Apply

Contract

15 - 18

Sr Claims Architect

Talent Groups

Remote • 21d ago

Easy Apply

Contract

Depends on Experience

Lead AI Data Engineer - Healthcare Payer Systems, Claims & Payment Integrity

UnivEdge Consulting LLC

Remote • 19d ago

Easy Apply

Contract

Depends on Experience

Property & Casualty Liability Claims Manager (Remote - Florida)

Davies

Remote or Birmingham, Alabama • 5d ago

Full-time

USD 120,000.00 - 140,000.00 per year

Principal Solutions Architect – Payer Claims Integration (Facets G6)

System One

Remote • 2d ago

Easy Apply

Contract

$97.25

Healthcare Claims Data Analyst

General Dynamics

Remote • Today

Full-time

USD 76,500.00 - 103,500.00 per year

Guidewire ClaimCenter Developer (Remote)

Kforce Technology Staffing

Remote or New York, New York • Today

Full-time

$105,000 - $115,000 annually

Director, AI/ML Engineering - Claims Automation & Orchestration - Remote

UnitedHealth Group

Remote or Eden Prairie, Minnesota • Today

Full-time

USD 176,700.00 - 302,900.00 per year

EPIC Tapestry Systems Quality Analyst - Remote

UnitedHealth Group

Remote or Eden Prairie, Minnesota • Today

Full-time

USD 72,800.00 - 130,000.00 per year

Senior Business Analyst Claims @ W2

Cyber Sphere LLC

Remote • 2d ago

Easy Apply

Contract

Depends on Experience

Epic PB Build Analyst / PB Claims Analyst

TekDallas

Remote • Today

Easy Apply

Contract

Depends on Experience

Solutions Architect (Healthcare Facets/Claims/GuidingCare (HealthEdge))

TalTeam

Remote • Today

Easy Apply

Contract

Depends on Experience

Power BI Developer-Healthcare / Medicaid / healthcare claims

StoneGate-Technologies LLC

Remote • Today

Easy Apply

Contract

$40,000 - $120,000

Workers Comp, Lost Time Claims Subject Matter Expert (User Research) - AI SaaS

EvolutionIQ

Remote or New York, New York • Today

Full-time

Director of Architecture for Agentic AI Claims Automation - Remote

UnitedHealth Group

Remote or Tempe, Arizona • Today

Full-time

USD 134,600.00 - 230,800.00 per year

Project Manager - PBM - PMP - Claims / Medicare - Medicaid

KE Staffing

Remote • 2d ago

Easy Apply

Contract

$60+

Job Details

Skills

Claims Management
Compensation Management
SIP
Workers Compensation
Lost time
Negotiation

Summary

Position: Claims Examiner - Workers Compensation

Duration: 03 Months of contract with Possible extension or conversion

Location: Rancho Cucamonga, CA onsite/hybrid (if residing within 25miles from office) or remote (within California)

Required Skills:

SIP is mandatory.
Lost time claims experience.
3+ years of relevant and recent worker's comp experience.

PRIMARY PURPOSE:

To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

Essential Functions and Responsibilities:

Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
Negotiates settlement of claims within designated authority.
Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
Prepares necessary state fillings within statutory limits.
Manages the litigation process; ensures timely and cost effective claims resolution.
Coordinates vendor referrals for additional investigation and/or litigation management.
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
Ensures claim files are properly documented and claims coding is correct.
Refers cases as appropriate to supervisor and management.
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.

Education & Licensing:

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience:

Five (5) years of claims management experience or equivalent combination of education and experience required.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10509960
Position Id: SED68217
Posted 6 days ago

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Contact the job poster

Sohel Contractor

Talent Acquisition Specialist @ Apidel Technologies

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Remote or Birmingham, Alabama

•

Today

Workers' Compensation Lost Time Adjuster (Remote) Department: Claims Administration & Adjusting Employment Type: Permanent - Full Time Location: Home United States Reporting To: Paula Humphreys Compensation: $70,000 - $75,000 / year Description Our Story Imagine being part of a team that's not just shaping the future but actively driving it. At Davies North America , we're at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As

Full-time

USD 70,000.00 - 75,000.00 per year

Property & Casualty Liability Claims Manager (Remote - Florida)

Remote or Birmingham, Alabama

•

5d ago

Property & Casualty Liability Claims Manager (Remote - Florida) Department: Claims Administration & Adjusting Employment Type: Permanent - Full Time Location: Home United States Reporting To: Jennifer Stiles Compensation: $120,000 - $140,000 / year Description Our Story Imagine being part of a team that's not just shaping the future but actively driving it. At Davies North America , we're at the forefront of innovation and excellence, blending cutting-edge technology with top-tier pro

Full-time

USD 120,000.00 - 140,000.00 per year

Senior Project Manager(Healthcare Claims Experience(Required))

Remote

•

7d ago

Role : Senior Project Manager Client : Government of North Carolina(NCDIT) Work Type : Remote Experience in Healthcare Claims Required(7 Years(Minimum)) Minimum Relevant Experience : 7 Years Max Payrate : 65$ Per Hour Duration : 12 Months(Extendable) eSystems Inc. is a fast-growing Systems Integrator based in Princeton, New Jersey. We provide strategic IT solutions and services with primary practice areas in Java and Microsoft centric e-Business solutions, ERP solutions, Enterprise Application I

Easy Apply

Contract, Third Party

55 - 65

Facets Analyst

Remote

•

14d ago

Over All Experience 8+years Facets with claims knowledge is must Facets, US healthcare payer domain, claims processing, analytical skills, oracle pl sql Good to have: .net

Easy Apply

Contract, Third Party

Depends on Experience