Job Details

BC Forward is hiring for Claims Examiner - Workers Compensation at Las Vegas, NV

Position: Claims Adjuster - Workers Compensation

Location: Las Vegas, NV (Remote)

Duration: 3 Months

Job type: Contract with possible extension

Pay Rate: $35.00/hr. on W2

Job Description:

Manager's Note:

Work Location: Remote or onsite. Preference is for onsite; however, experienced candidates licensed in NV may be considered for remote work. NV license is mandatory.

PRIMARY PURPOSE:

Analyze mid- and higher-level workers' compensation claims to determine benefits due, ensure ongoing adjudication aligns with company standards and industry best practices, and identify subrogation opportunities while negotiating settlements.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Manage workers' compensation claims by determining compensability and benefits due on long-term indemnity claims. Monitor reserve accuracy and file required documentation with state agencies.
• Develop and manage claims action plans to resolution, coordinate return-to-work efforts, and approve claim payments.
• Approve and process assigned claims, determine benefits due, and manage action plans pursuant to the claim or client contract.
• Manage subrogation of claims and negotiate settlements.
• Communicate claim actions with claimants and clients.
• Ensure claim files are properly documented and claims coding is accurate.
• Process complex lifetime medical and/or defined-period medical claims, including state and physician filings, and decisions on appropriate treatments recommended by utilization review.
• Maintain professional client relationships.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES:

• Perform other duties as assigned.
• Support the organization's quality programs.
• Travel as required.

QUALIFICATIONS:

Education & Licensing:

• Bachelor's degree from an accredited college or university preferred.
• NV license required.

Experience:

• Four (4) years of claims management experience or an equivalent combination of education and experience.

Skills & Knowledge:

• Working knowledge of regulations, offsets and deductions, disability duration, medical management practices, and Social Security and Medicare application procedures as applicable to the line of business.
• Excellent oral and written communication skills, including presentation abilities.
• PC literate, including Microsoft Office products.
• Strong analytical and interpretive skills.
• Excellent organizational skills.
• Strong interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Service Expectations.