Job Details

[Remote] Medical Only - Claims Adjuster, Workers Compensation (California)

Required Skills

Job Description

Job Title: [Remote] Medical Only - Claims Adjuster, Workers Compensation (California)

Job Type: Full-time

Location: Remote (Open to candidates in the USA)

Job Summary

Join our team as a Medical Only - Claims Adjuster specializing in California Workers Compensation. You will play a pivotal role in managing medical-only and lien claims remotely, ensuring compliance with state regulations, and delivering an outstanding customer experience. This is a fantastic opportunity to make a meaningful impact using your strong communication skills and workers compensation expertise.

Key Responsibilities

• Manage and adjudicate California workers compensation medical-only and lien claims from initial report to closure.
• Maintain timely, accurate, and thorough claim file documentation in compliance with regulatory and internal guidelines.
• Communicate proactively with claimants, medical providers, legal representatives, and employers to ensure positive outcomes and customer satisfaction.
• Identify, investigate, and resolve claim-related issues, prioritizing cost containment and best-in-class service delivery.
• Review and approve medical bills, monitor treatment plans, and evaluate liens, ensuring appropriate payments.
• Stay current on California workers compensation law and regulatory changes to ensure proper claims handling.
• Collaborate with internal team members and stakeholders to promote continuous improvement and knowledge sharing.

Required Skills and Qualifications

• 2+ years of experience handling California workers compensation medical-only or lien claims.
• Strong written and verbal communication skills, with a commitment to professional and empathetic interactions.
• In-depth knowledge of California workers compensation laws, regulations, and best practices.
• Proficiency with claims management systems and digital documentation tools.
• Excellent organizational skills with the ability to manage competing priorities in a remote environment.
• Demonstrated problem-solving abilities and attention to detail.
• Proactive, self-motivated, and comfortable working independently as part of a remote team.

Preferred Qualifications

• California Self-Insurance Administrator certification.
• Experience managing claims involving complex medical treatments or high-volume caseloads.
• Bilingual in English and Spanish.

We are committed to fostering a supportive, remote work environment where your expertise and dedication to quality service will be valued and recognized. If you are passionate about delivering excellent outcomes for injured workers and their employers, we invite you to consider joining our team.