Claims Representative long Beach 8982

Job Description

Job 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