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Claims Examiner - Workers Compensation

Company: The Judg
Location: Riverside
Posted on: November 20, 2022

Job Description:

Location: Riverside, CA Salary: N/A Description: Our client is currently seeking a Claims Examiner - Workers Compensation Worksite Location: Riverside, CA (Remote for local candidates) MANAGER NOTES: Candidate must have 5+yrs California examining experience. - if candidate is from other States, MUST have recent California claims handling experience and MUST hold the California Examiner Designation certificate as well as the Self Insurance Certificate. PRIMARY PURPOSE: To provide high quality service to both internal and external customers, delivering an easy and efficient customer experience for routine lost time. - ESSENTIAL FUNCTIONS and RESPONSIBILITIES -

  • Processes incoming calls, faxes and voicemails from claimants, providers, clients, attorneys, etc., resolving their claims related questions and issues in accordance with designed guidelines and policies. -
  • Communicates claims status and current claim activity with client and appropriate medical contact; responds to inquiries about jurisdiction- and claim-specific issues. -
  • Enters data into claims system(s) and ensures claim files are properly documented and claims coding is correct. Coordinates claimant address updates or changes with internal departments. Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit (SIU) as appropriate and coordinates independent medical examinations.
  • Performs other duties as assigned. Supports the organization's quality program(s). - QUALIFICATIONS Education & Licensing -
    • High school diploma or GED required. Associate's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
    • Experience Two (2) years of administrative and/or customer service experience or equivalent combination of education and experience required. -
    • Skills & Knowledge Excellent oral and written communication skills PC literate, including Microsoft Office products Strong investigation and organizational skills Good interpersonal skills Ability to work in a team environment .
    • Ability to meet or exceed Performance Competencies - WORK ENVIRONMENT: -
      • When applicable and appropriate, consideration will be given to reasonable accommodations. -
      • Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines -
      • Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time Contact: rmurari@judge.com

        This job and many more are available through The Judge Group. Find us on the web at

Keywords: The Judg, Riverside , Claims Examiner - Workers Compensation, Other , Riverside, California

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