Claim adjuster Jobs in Clovis, CA

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Training & development
• Vision insurance
• 401(k)
• Competitive salary
• Free uniforms
• Stock options plan
• Tuition assistance

Benefits/Perks

• Great small business work environment
• Paid time off, health insurance, dental insurance, retirement benefit, and more!

Company Overview
American Family Care (AFC) is one of the largest primary and urgent care companies in the U.S. providing services seven days a week on a walk-in basis. Our state-of-the-art centers focus on the episodic treatment of acute illnesses and injuries, workers' compensation, and occupational medicine. Each location is equipped with an onsite lab and in-house x-ray capability.
AFC is the parent company of AFC Franchising, LLC (AFCF). This position works directly with a franchised business location. The specific job duties and benefits can vary between franchises.

Job Summary
The Workers’ Compensation Case Coordinator is responsible for facilitating and overseeing the care of patients with work-related injuries. This role ensures timely authorization, treatment, and communication between injured workers, providers, employers, insurance adjusters, and case managers. The Coordinator helps manage claims, supports return-to-work goals, and ensures all documentation and services are compliant with workers’ comp regulations and payer requirements.
This position coordinates all workers compensation activities, including obtaining medical authorization and processing dictated reports. It requires strong organizational skills and attention to detail.



Responsibilities

• Client communication via phone and email
• Scheduling medical appointments for clients
• Communicating case status to clients
• Responding to client, adjuster, and legal calls
• Requesting records from referral sources and medical offices
• Confirming medical appointments
• Provide timely reports upon request via fax, email or US mail
• Coordinate all aspects of care for patients with active workers’ compensation claims
• Receive and process referrals from adjusters, nurse case managers, and providers
• Maintain updated tracking list for all workers’ compensation accounts
• Confirm claim details, authorizations, and coverage with insurers and third-party administrators (TPAs)
• Schedule appointments and facilitate the authorization of DME, therapy, diagnostics, prescriptions, or follow-up care
• Ensure required documentation is complete, including medical records, work status reports, and treatment plans
• Maintain open communication with all stakeholders: injured workers, employers, adjusters, nurse case managers, and treating physicians
• Monitor claim progress, follow up on pending authorizations, and escalate delays when needed
• Report modified work duties and return-to-work plans in collaboration with providers and employers
• Update case notes, status logs, and electronic health records (EHR) in a timely and accurate manner
• Ensure services comply with jurisdiction-specific workers’ compensation laws and organizational protocols.
• Maintain confidentiality and adhere to HIPAA and workers’ compensation regulations.
• Maintain accurate and up-to-date records of all workers' compensation claims, ensuring compliance with legal requirements and company policies.
• Perform other duties as assigned

Qualifications

• Minimum 1 years of experience in Workers’ Compensation, healthcare administration, or related field
• Able to effectively manage a workers' compensation file under the supervision of assigned supervisor
• Knowledge of insurance verification and billing & coding experience is a plus
• Certification in workers' compensation administration or a related field is a plus
• Understanding of California's workers' compensation system, including relevant laws, regulations, and procedures
• Familiarity with medical terminology and understanding of healthcare processes related to workers' compensation claims
• Maintaining accurate and up-to-date records of all claims, communications, and activities related to the workers' compensation process
• Experience working with insurance providers, legal professionals, and healthcare providers related to workers' compensation claims
• Attention detail
• Ability to handle stressful situations and work well under pressure
• Ability to work independently and as part of a team
• Excellent communication, organization, and time management skills
• Ability to multi-task and prioritize in a fast-paced environment
• General office skills, 35 wpm keyboard speed, computer experience including but not limited to Microsoft Office, web-based applications, e-mail, internet, fax machine, and copy machine
• Education in Medical Courses preferred, but not required
• Bilingual in Spanish preferred, but not required