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Claims Specialist-wc Job In Brea, California, Abacus Service Corporation

Published 2022-09-23
Expires 2022-10-23
ID #1181639805
Free
Claims Specialist-wc Job In Brea, California, Abacus Service Corporation
United States, California, Brea,
Published September 23, 2022

Job details:

Job type: Full time
Contract type: Permanent
Salary type: Per annum
Occupation: Claims specialist-wc


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Description





Department:

06311 | SRMS | R0036 | BUS : BP WC Brea - 06311



Job Category:

Claims



Job Code:

Claims Specialist-WC:BS0365



Job Title:

Claims Specialist-WC



Keywords:



Number of Positions:

1



Remaining Positions:

1



Duties:

Conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages. Works closely with claimants, witnesses and members of the medical profession and other persons pertinent to the investigation and processing of claims. - Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim. - Identifies wage loss expenses and wage exposures on medical claims. - Documents receipt and contents of medical reports. Interacts frequently with claimant to understand nature and extent of injury and medical conditions. Reviews and handles other correspondence within authority including material from the team members, and/or clients. - Approves payments of medical bills on lost time disability claims within area of payment authority up to, but not exceeding, (USD)2,500 after compensability has been determined. - Evaluates medical claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations. - Keeps Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Team Manager for direction. - With the team managers guidance, provides input on the completion of status reports, initiate's activity checks and/or widow's statement of dependency forms. - Completes all reporting forms and file documentation. - Adheres to client and carrier guidelines and prepares written updates for supervisor to review.



Skills:

Demonstrates a thorough working knowledge of claim processing and claim policies and procedures. - Demonstrates an understanding of basic medical terminology and appropriate medical tests for claimed conditions - Demonstrates effective and diplomatic oral and written communication skills. - Demonstrates a customer-focused approach including the ability to identify and understand customer needs, and interacts effectively with others.



Education:

College degree or the equivalent of education and experience. - Knowledge of claims and familiarity with claims terminology gained through industry experience and/or through specialized courses of study (Associate in Claim designation, etc). - Must have or secure and maintain the appropriate license(s) as required by the state(s) at the adjuster/supervisory/management level. - Must possess a valid driver's license.



Languages:



English

Read

Write

Speak



Attachments:



Skills and Experience



Skills:



Required



CLAIMS



CORRESPONDENCE



DISABILITY



PAYMENTS



DOCUMENTATION



Additional



MANAGEMENT LEVEL



MEDICAL TERMINOLOGY



MEDICAL CLAIMS



LIABILITY



OFFICE MEDICAL



Languages:

English( Speak, Read, Write )



Minimum Degree Required:



Also Preferred:



Location



Client Location



Country:

United States



State/Province:

California



City:

Brea



Address:

675 Placentia Avenue, Suite 350, CA0001



Postal Code:

92821



Work Location



Same as Client Location



Other Client Location



Work Completed Offsite



Schedule



Start Date:

09/25/2022

Hours Per Week:

40.00



Est. End Date:

02/25/2023

Hours Per Day:

8.00



Schedule Notes:



Days Per Week:

5.00



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    Employer's info

    Registered on October 7, 2017

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    Marketing is the study and management of exchange relationships. The American Marketing Association has defined marketing as "the activity, set of institutions, and processes for creating, communicating, delivering, and exchanging offerings that have value for customers, clients, partners, and society at large." Marketing is used to create, keep and satisfy the customer. With the customer as the focus of its activities, it can be concluded that Marketing is one of the premier components of Business Management - the other being Innovation.


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