Claims Representative (IAP) - Workers Compensation Training Program | San Diego & Roseville

PRIMARY PURPOSE OF THE ROLE

To be oriented and trained as a new industry professional. This role begins with a comprehensive 4-week concept-based learning and professional training program, followed by a dedicated onboarding experience before entering the on-the-job phase. You will be assigned a mentor and manager that will support and guide you on your career journey and be equipped with the foundational skills needed for a successful career in claims adjusting. While in the program, you’ll have the opportunity to grow and advance within the industry.

ARE YOU AN IDEAL CANDIDATE?

• Strong Communicators
• Empathetic
• Multitaskers
• Accountable
• Structured Thinkers
• Ambitious
• Aglle Learners
• Team Collaborators

ESSENTIAL RESPONSIBILITIES INCLUDE

• Attendance and completion of designated claims professional training program.
• Adjusting various levels of workers’ compensation claims under close supervision, which includes:
• Processing and responding to incoming mail, emails and other claim related documents according to status of the claim.
• Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives, primarily through telephonic, video conference and email.
• Thoroughly investigating new and existing claims by gathering relevant information including medical records, employer reports, and witness statements.
• Investigating employer/employee relationships, policy verification, coverage and any potential for subrogation issues or fraud indicators.
• Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements.
• Documenting claims files and properly coding claim activity.
• Preparing detailed reports documenting findings and recommendations.
• Administering claim benefits i.e., indemnity and medical benefits, through maintenance of calendared claim-related action items, ensuring state compliance.
• Participating in virtual and/or in-person meetings, claim reviews and business functions as needed for educational training, claim discussions and various meetings.

Qualifications

• Education Requirement – High School Diploma or GED.
• Bachelor's degree preferred and 2 years of customer service experience and/or combination of education and experience.

Work Environment Requirements

• 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.
• Auditory/Visual: Hearing, vision and talking.