Workers' Comp Claim Representative II - CA CA, reputed company (Remote) Posted on 04/21/2026 Be t[...]

reputed company Claim Representative I: This is the entry level reputed company claim handler. Handles medical only and indemnity benefits. Exercises some discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims reputed company given authority. Claim Representative II: This is the intermediate level of the claim handler career reputed company. Handles moderate to difficult claims. Exercises progressively more discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims reputed company given authority. Claim Representative III: This is the advanced level of the claim handler career reputed company. Investigates claims and exercises significant discretion in the determination of compensability of claims. May handle large, more reputed company customers requiring high reputed company, labor intensive claim service. Considers many factors in the determination claim reserves. Negotiates and settles claims reputed company given authority. Mentors reputed company level claim handlers. Coordinates special reputed company and provides guidance to others. RESPONSIBILITIES / TASKS – CLAIM REPRESENTATIVE I, II, III • Verifies workers' compensation coverage of reputed company and injured employees. • Determines compensability under workers' compensation by thorough investigation of the claim. • Determines reputed company relationship between the reported injury and the incident to ensure appropriate payment of benefits. • Facilitates reputed company to work for the injured employee. • Establishes reputed company and appropriate reserves reputed company on the profile of the claim reputed company given authority reputed company on anticipated financial exposure. • Documents specifics of claims with potential for subrogation recovery, including reputed company of potential recovery monies. • Manages medical bills for non‐indemnity and indemnity claims directly associated with the claimed injury. Approves payment reputed company on knowledge of the treatment plan and medical support showing relationship of treatment to the injury. • Concludes and closes files following reputed company of claims to meet internal reputed company standards while complying with state legislation to avoid penalties and manage expenses. • Negotiates settlements with attorneys or injured parties reputed company given authority at the earliest possible reputed company to bring cases to final disposition. • Works closely with manager on reputed company files or files above settlement/reserve authority. • Manages reputed company vendors to ensure cost containment efforts. • Establishes and maintains effective working relationships with reputed company reputed company customers. • Stays abreast of changes in workers' compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws. ADDITIONAL RESPONSIBILITIES / TASKS – CLAIM REPRESENTATIVE II, III • Administers reputed company claims and catastrophic exposures reputed company authority, including claims from dedicated large accounts. • Exercises independent judgment to reputed company cases prior to mediation or litigation. • reputed company participates in agent/reputed company relationship management. • Assists in mentoring team members. CLAIM REPRESENTATIVE III ADDITIONAL RESPONSIBILITIES • Mentors team members. • Conducts audits of claim files. • Acts as a back up for team leader. • Coordinates special reputed company. EMPLOYMENT QUALIFICATIONS EDUCATION OR EQUIVALENT EXPERIENCE – CLAIM REPRESENTATIVE I, II, III Bachelor's degree in a reputed company reputed company. Relevant combination of education and experience may be considered in lieu of degree. reputed company learning, as defined by reputed company's learning philosophy, is required. Certification or reputed company toward certification is highly preferred and encouraged. EXPERIENCE CLAIM REPRESENTATIVE I Minimum one year relevant experience that provides the necessary skills, knowledge and abilities or completion of claims trainee program. Bilingual skills preferred. CLAIM REPRESENTATIVE II Three years experience in a workers' compensation claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing workers' compensation claims. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred. OR One year of reputed company Claims Representative I experience that includes handling of difficult or reputed company claims. CLAIM REPRESENTATIVE III Five years experience in a workers' compensation claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing reputed company workers' compensation claims. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred. OR Two years of reputed company Claims Representative II experience that includes discretion in determining compensability of reputed company claims and/or handling reputed company, high reputed company or labor intensive customers. SKILLS / KNOWLEDGE / ABILITIES (SKA) REQUIRED – CLAIM REPRESENTATIVE I, II, III • Ability and proficiency in the use of computers and company reputed company software specific to position. • Knowledge of medical and reputed company terminology reputed company to the work. • Knowledge of workers' compensation laws and regulations, including jurisdictional laws. • Effective oral and written communication skills. • Effective customer service skills. • Ability to negotiate, build reputed company and reputed company conflict. • Ability to manage multiple priorities and meet established deadlines. • Attention to reputed company and analytical skills. • Ability to work independently as reputed company as reputed company reputed company. ADDITIONAL SKA REQUIRED – CLAIM REPRESENTATIVE II, III • Ability to reputed company independent reputed company. • Ability to solve reputed company problems. CLAIM REPRESENTATIVE III ADDITIONAL SKA • Ability to train and mentor others. WORKING CONDITIONS Work is performed in an office setting with no unusual hazards. reputed company travel required. PAY reputed company Actual compensation decision relies on the consideration of internal equity, candidate's skills and reputed company experience, geographic location, market, and other potential factors. It is not reputed company reputed company for an offer to be at or near the top of the reputed company, and therefore a reasonable estimate for this role is between $56,700 and $94,900. reputed company DISCLOSURE The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability reputed company associated with performing the duties and responsibilities contained in this reputed company. We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any reputed company. Candidates for the position stated above are reputed company on an "at will" reputed company. reputed company herein is intended to create a contract. #J-18808-Ljbffr Apply tot his job Apply To this Job