Claims Professional

Job Description

Job Description

We are looking for a skilled Claims Specialist to join our team in Los Angeles, California. . The ideal candidate will bring expertise in managing workers' compensation claims and ensuring seamless communication between all parties involved.

Responsibilities :

• Manage a portfolio of modified duty and lost time claims with efficiency and accuracy.
• Forward medical records related to workplace injuries to the appropriate insurance adjuster.
• Input data from medical records into the system while maintaining attention to detail.
• Notify supervisors of initial diagnoses and work status for injured employees.
• Support the Hospital Manager and injured employees in implementing early return-to-work programs.
• Schedule and track follow-up doctor appointments, ensuring medical statuses are documented within 24 hours of each visit.
• Communicate appointment outcomes to insurance adjusters and supervisors promptly.
• Monitor lost time and modified work data, updating the system regularly.
• Maintain regular communication with insurance adjusters, providing updates at least every 60 days until claims are resolved.
• Conduct audits of claim data and related records consistently to ensure accuracy
• Minimum of 2 years of experience in handling workers' compensation claims.
• Strong understanding of medical management processes in workplace injury claims.
• Proficiency in data entry and maintaining accurate records.
• Effective communication skills for liaising with supervisors, insurance adjusters, and medical professionals.
• Ability to organize and track follow-up appointments and outcomes efficiently.
• Experience with auditing claim and related data to ensure compliance and accuracy.
• Familiarity with early return-to-work programs for injured employees.
• Knowledge of workers' compensation regulations and procedures.