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28 results (3 new)

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Worker Compensation Claims Examiner III/CA-Hybrid

HCM Staffing and Consulting

Rancho Cordova, California • Today

Easy Apply

Third Party, Contract

Depends on Experience

Claims Examiner - Workers Compensation - W2 Only

Apidel Technologies

Remote • 8d ago

Easy Apply

Contract

52 - 56

Case Manager (LTD/IDI Claims)

BOTG LLC

Remote • 15d ago

Easy Apply

Contract

$45 - $50

Claims Technical Specialist

SANS

Remote • Today

Easy Apply

Contract

Depends on Experience

Claims Examiner - Workers Compensation W2 Only

Apidel Technologies

Remote • 8d ago

Easy Apply

Contract

48 - 52

Workers Compensation Claims Examiner - W2 Only

Apidel Technologies

Remote • 8d ago

Easy Apply

Contract

50 - 54

Physician ED Claims (Remote)

Pacific Consultancy Services

Remote • Yesterday

Easy Apply

Third Party, Contract

Depends on Experience

Physician ED Claims Reviewer

W3Global

Remote or Minnesota • Today

Full-time, Contract

USD100000.0/ANNUAL - USD105000.0/ANNUAL

Physician ED Claims Reviewer

Nityo Infotech Corporation

Remote • Yesterday

Easy Apply

Full-time

Depends on Experience

Annuity Claims Specialist

SynergisticIT

Remote • Today

Easy Apply

Contract

$40 - $45

Claims Adjuster - General Liability

Apidel Technologies

Remote • Yesterday

Easy Apply

Contract

40 - 44

Epic Tapestry Consultant – Claims Connect

Codeforce 360

Remote • 7d ago

Easy Apply

Third Party, Contract

$75 - $78

Remote NJ, NY, NE - MedMal Claims Examiner

Kforce Technology Staffing

Remote or New York, New York • Today

Full-time

$100,000 - $125,000 annually

Claims AI Business Analyst IV

CareSource

Remote or Dayton, Ohio • Today

Full-time

USD 94,100.00 - 164,800.00 per year

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

EvolutionIQ

Remote or New York, New York • Today

Full-time

Data Analyst Claims

Mercury Insurance

Remote • Today

Full-time

USD 76,829.00 - 142,213.00 per year

Sr. QA/Tester with Healthcare claims

Infinite Computer Solutions (ICS)

Remote • Yesterday

Easy Apply

Full-time

Up to $80,000

Epic Certified Hospital Billing & Claims Analyst

Sagarsoft

Remote • Today

Easy Apply

Contract

50 - 60

Distinguished Architect, Software Development - Claims Processing Platform

CVS Health

Remote or Texas • Today

Full-time

USD 175,100.00 - 334,750.00 per year

MMIS Claims Tester

RyanBPM

Remote • 7d ago

Easy Apply

Contract, Third Party

$40 - $45

Healthcare Claims Resolution Specialist - Remote US

Gainwell Technologies LLC

Remote or Dallas, Texas • Today

Full-time

USD 26,500.00 - 37,800.00 per year

Healthcare Claims Resolution Specialist - Remote US

Gainwell Technologies LLC

Remote or Houston, Texas • Today

Full-time

USD 26,500.00 - 37,800.00 per year

Healthcare Claims Resolution Specialist - Remote US

Gainwell Technologies LLC

Remote or Austin, Texas • Today

Full-time

USD 26,500.00 - 37,800.00 per year

Epic Resolute HB/PB/Claims Consultant (Production Support) (W2 only)

Nasscomm, Inc.

Remote • 6d ago

Easy Apply

Contract

Depends on Experience

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

Medical Claims Auditor (Remote - Texas)

Gainwell Technologies LLC

Remote or Austin, Texas • Today

Full-time

USD 50,000.00 - 55,000.00 per year

Medical Claims Auditor (Remote - Texas)

Gainwell Technologies LLC

Remote or Dallas, Texas • Today

Full-time

USD 50,000.00 - 55,000.00 per year

Medical Claims Auditor (Remote - Texas)

Gainwell Technologies LLC

Remote or Houston, Texas • Today

Full-time

USD 50,000.00 - 55,000.00 per year

HCM Staffing and Consulting

Job Details

Skills

Workers Compensation
Work Comp Lost Time
Minimum five (5) or more years related experience; or equivalent combination of education and experience.

Summary

TITLE: Workers compensation Claims Examiner III/Hybrid/CA-Hybrid
TERM: Contract to Hire
LOCATION: Rancho Cordova 95670 , (Sacramento, CA 10995)
hybrid position-two (2) days in office after training (training 2-3 weeks)
HOURS: MON-FRI 8:00-5:00 PM
SALARY RANGE: $85,000-$95,000/year (depending on experience)

SIP Required!

POSITION SUMMARY: At the Direction of the Claims Supervisor and/or Manager, manages all aspects of complex and litigated indemnity claims from inception to conclusion within established authority and guidelines.

This position requires considerable interaction with clients, claimants, medical providers, Attorneys, vendors, Nurse and Vocational Case Managers, and other Company staff.

DUTIES AND RESPONSIBILITIES:

Effectively manages a caseload of indemnity claim files, including very complex and litigated claims.*
Initiates and conducts investigations in a timely manner.*
Determines compensability of claims and administers benefits based upon state law and Company Best Practices for claim handling.*
Manages medical treatment and medical billing, authorizing as appropriate.*
Refers cases to outside defense counsel and participates in litigated matters.*
Communicates with claimants, attorneys, providers and vendors regarding claims issues.*
Works in an organized and proactive manner.*
Computes and sets reserves within Company guidelines.*
Settles and/or finalizes all claims and obtains authority as designated.*
Maintains a diary system for case review and documents the file to reflect the status and work being performed on the file, including a plan of action.*
Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.*
Conducts file reviews as scheduled by the client and management.*
Identifies and reviews claims for Apportionment assignment.*
Identify and investigate subrogation potential and pursue recovery.*
Identify claim standard criteria for excess reporting and reimbursement.*
Assist with State Audit and reporting responses.*
Mentors less experienced Examiners
Other duties as assigned and including claims management of other jurisdictional workers’ comp claims.
Adheres to all company policies and procedures.*

* Essential job function.

EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire

QUALIFICATIONS REQUIRED:

Education/Experience: Minimum five (5) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities:

Technical knowledge of statutory regulations and medical terminology.
Analytical skills.
Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
Ability to interact with persons at all levels in the business environment.
Ability to independently and effectively manage very complex claims.
Proficient in Word and Excel (preferred).

Other Qualifications:
Licenses as required by jurisdiction.

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: 91121648
Position Id: 44846
Posted 2 hours ago

Company Info

About HCM Staffing and Consulting

HCM is currently one of the fastest growing minority and veteran certified global staffing organizations. Our tremendous growth has been driven organically and through merger and acquisition. It's a truly exciting time to be part of our world class white glove delivery model to our client partners.

Fitment

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Rowena Leyva

Recruiter @ HCM Staffing and Consulting

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More jobs at HCM Staffing and Consulting in Rancho Cordova, CA

HCM Staffing and Consulting

Job Details

Skills

Workers Compensation
Work Comp Lost Time
Minimum five (5) or more years related experience; or equivalent combination of education and experience.

Summary

Effectively manages a caseload of indemnity claim files, including very complex and litigated claims.*
Initiates and conducts investigations in a timely manner.*
Determines compensability of claims and administers benefits based upon state law and Company Best Practices for claim handling.*
Manages medical treatment and medical billing, authorizing as appropriate.*
Refers cases to outside defense counsel and participates in litigated matters.*
Communicates with claimants, attorneys, providers and vendors regarding claims issues.*
Works in an organized and proactive manner.*
Computes and sets reserves within Company guidelines.*
Settles and/or finalizes all claims and obtains authority as designated.*
Maintains a diary system for case review and documents the file to reflect the status and work being performed on the file, including a plan of action.*
Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.*
Conducts file reviews as scheduled by the client and management.*
Identifies and reviews claims for Apportionment assignment.*
Identify and investigate subrogation potential and pursue recovery.*
Identify claim standard criteria for excess reporting and reimbursement.*
Assist with State Audit and reporting responses.*
Mentors less experienced Examiners
Other duties as assigned and including claims management of other jurisdictional workers’ comp claims.
Adheres to all company policies and procedures.*

Technical knowledge of statutory regulations and medical terminology.
Analytical skills.
Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
Ability to interact with persons at all levels in the business environment.
Ability to independently and effectively manage very complex claims.
Proficient in Word and Excel (preferred).

Other Qualifications:
Licenses as required by jurisdiction.

Dice Id: 91121648
Position Id: 44846
Posted 2 hours ago

Company Info

About HCM Staffing and Consulting

Fitment

Dice Job Match Score™

📋 Comparing job requirements...

Contact the job poster

Rowena Leyva

Recruiter @ HCM Staffing and Consulting

View Profile

Create job alert

Never miss an opportunity! Create an alert based on the job you applied for.

Similar Jobs

It looks like there aren't any Similar Jobs for this job yet.

Search all similar jobs

More jobs at HCM Staffing and Consulting in Rancho Cordova, CA