Claims Professional

Claims Specialist

We are looking for a skilled Claims Specialist to join our team in Los Angeles, California. The ideal candidate will bring expertise in managing workers' compensation claims and ensuring seamless communication between all parties involved.

Responsibilities :

• Manage a portfolio of modified duty and lost time claims with efficiency and accuracy.
• Forward medical records related to workplace injuries to the appropriate insurance adjuster.
• Input data from medical records into the system while maintaining attention to detail.
• Notify supervisors of initial diagnoses and work status for injured employees.
• Support the Hospital Manager and injured employees in implementing early return-to-work programs.
• Schedule and track follow-up doctor appointments, ensuring medical statuses are documented within 24 hours of each visit.
• Communicate appointment outcomes to insurance adjusters and supervisors promptly.
• Monitor lost time and modified work data, updating the system regularly.
• Maintain regular communication with insurance adjusters, providing updates at least every 60 days until claims are resolved.
• Conduct audits of claim data and related records consistently to ensure accuracy.

Requirements :