Certified Workers' Compensation Claims Examiner

Job Description

Job Description

We are seeking a motivated individual for this position.

This position is on-site in Martinez and requires a local candidate.

Schedule :

Monday Friday 8 : 00 am to 5 : 00 pm.

Location : On-site in Martinez, CA

Requirements :

• Certification : Must be a current Certified Claims Adjuster in the State of California pursuant to Title 10 of CCR2592 or possess the Self-Insurance Certificate issued by the State of California.
• Education : Completion of 60 semester or 90 quarter units from an accredited college or university, including at least six semester or nine quarter units in business, public administration, insurance, physical science, finance, or a closely related field.
• Substitution : Additional experience may be substituted for education on a year-for-year basis, up to two (2) years.
• Experience : Minimum of three (3) years of full-time work as a Workers' Compensation Claims Adjuster I or in an equivalent role with an insurance carrier or third-party claims administrator focused on workers' compensation indemnity claims.

Knowledge, Skills, and Abilities :

1. Strong understanding of Workers' Compensation insurance principles, legal statutes, and civil procedures.

2. Familiarity with medical and legal terminology, Medicare Set-asides, and the Americans with Disabilities Act (ADA).

3. Ability to interpret legal statutes, analyze evidence, prioritize claims, and calculate benefits accurately.

4. Experience in maintaining effective working relationships with stakeholders (employers, physicians, attorneys, etc.).

5. Skilled in preparing clear, concise reports and oral presentations.

6. Proficient in documenting work using Workers' Compensation Claims software and managing electronic claim files.

Typical Tasks :

Investigating and adjusting job-related injury claims, making determinations regarding compensability, medical treatment, disability compensation, and death benefits.

Interviewing claimants, witnesses, supervisors, and physicians to assess claim credibility.

Assisting legal counsel in case development, settlement negotiations, and Workers' Compensation Appeals Board representation when necessary.

Preparing reports, correspondence, and maintaining accurate claim files.

Managing referrals to ADA Coordinators and monitoring alternative work programs.

Collaborating with external vendors for utilization review and handling excess insurance cases.

1027

EEO / AA Employer / Vet / Disabled.

The Know Your Rights poster is available here :

https : / / www.eeoc.gov / sites / default / files / 2023 -06 / 22- 088 EEOC KnowYourRights6.12.pdf

The pay transparency policy is available here :

https : / / www.dol.gov / sites / dolgov / files / ofccp / pdf / pay - transp %20English formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.

https : / / e- verify.uscis.gov / web / media / resourcesContents / E - Verify Participation Poster ES.pdf

Company Description

Founder and CEO, Janice Bryant Howroyd, is a North Carolina native who left her hometown in 1976 armed with $1500. Since then, she has dedicated her efforts to building an organization that is committed to keeping the humanity in Human Resources and Strategic, Inclusive Procurement.

Mrs. Howroyd’s commitment to excellence has grown ActOne Group to 33 countries, with over 17,000 clients and more than 2,800 employees.

The largest woman-minority-owned workforce management company founded in the US, ActOne Group professionals bring expertise in delivering corporate HR initiatives to local and global markets.

Mrs. Howroyd was selected by former President Barack Obama to serve as a White House appointee and continues to serve under the current administration as an Ambassador of Energy.

Mrs. Howroyd gives generously through funding and advocacy for STEM education, particularly for women and minorities.

Mrs. Howroyd leads her teams to build business success based on the ability to connect great companies with outstanding talent.

Her passion for education, mentorship, and self-empowerment initiatives have earned her many professional and philanthropic recognitions.

She is a sought after speaker and media subject matter expert in her fields. Her book, The Art of Work : How to Make Work, Work for You, is available on Amazon.com.

Company Description

Founder and CEO, Janice Bryant Howroyd, is a North Carolina native who left her hometown in 1976 armed with $1500. Since then, she has dedicated her efforts to building an organization that is committed to keeping the humanity in Human Resources and Strategic, Inclusive Procurement.

r n r nMrs. Howroyd’s commitment to excellence has grown ActOne Group to 33 countries, with over 17,000 clients and more than 2,800 employees.

The largest woman-minority-owned workforce management company founded in the US, ActOne Group professionals bring expertise in delivering corporate HR initiatives to local and global markets.

r n r nMrs. Howroyd was selected by former President Barack Obama to serve as a White House appointee and continues to serve under the current administration as an Ambassador of Energy.

Mrs. Howroyd gives generously through funding and advocacy for STEM education, particularly for women and minorities. r n r nMrs.

Howroyd leads her teams to build business success based on the ability to connect great companies with outstanding talent.

Her passion for education, mentorship, and self-empowerment initiatives have earned her many professional and philanthropic recognitions.

She is a sought after speaker and media subject matter expert in her fields. Her book, The Art of Work : How to Make Work, Work for You, is available on Amazon.com.