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About the role
Key responsibilities & impact- Provide initial research and data collection on claims files
- Perform file audits according to jurisdictional standards directed by state, carrier, or client
- Review prior audit results, settled files, or inactive files and identify exceptions
- Coordinate file retrieval and gather data for management submission
- Communicate with claim examiners to correct deficiencies, provide corrected payment amounts, and give instructions regarding necessary state form filing
- Monitor correction of audit exceptions and assist with filing state forms and submitting payments
- Research exceptions on the state's quarterly compliance report and provide detailed responses to management identifying trends
- Review and update notes and diaries in the claims management system
- Coordinate jurisdictional training on state-specific tools
- Support the organization's quality programs
- Perform other duties as assigned
- Work closely with Workers’ Compensation Program Managers, medical facilities, third-party administrators, clients, and staff
Requirements
What you’ll need- Two (2) years of claims experience or equivalent combination of education and experience required
- High school diploma or GED required
- Knowledge of state workers’ compensation statute
- Proficient math skills
- Skilled with Excel spreadsheets
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
- Computer keyboarding
- Hearing, vision, and talking
- Clear and conceptual thinking ability
- Excellent judgement and discretion
- Ability to meet deadlines
Benefits
Comp & perks- Hybrid work: 2 days in the Sacramento, CA office and 3 days working from home
- Career development and promotional growth opportunities through increasing responsibilities
- Comprehensive benefits package including medical, dental, vision, 401k and matching, PTO, disability and life insurance
- Employee assistance program
- Flexible spending or health savings account
- Additional voluntary benefits
- Work-life balance
- Diversity, equity, and inclusion workplace
- Drug-free workplace