Workers Compensation Lien Claims Professional

ESSENTIAL RESPONSIBILITIES

Thoroughly reviews assigned claim files and provides detailed summary of lien exposure, vendor involvement, and potential issues. Creates a resolution-focused plan of action, sets appropriate diaries, and calculates appropriate reserves. Updates strategy and reserves as information becomes available within authority parameters. Seeks additional authority timely as needed.

Analyzes vendor billing in each claim file and identifies discrepancies or misalignment with claim documentation. Proactively makes inquiries to obtain information needed for actionable use.

Makes prompt, sound decisions on lien issues and offers that arise and documents thoroughly in claims file. Collaborates routinely with defense counsel, Adjusting, Medical Management, and SIU teams on lien issues. Ensures clear, timely communications to all parties on outstanding issues. Ensures actions are coordinated amongst relevant parties to achieve optimal resolution outcome.

Recommends lien settlements, responds to lien demands at appropriate time and value and effectively negotiates settlement with vendor/provider or refers to defense counsel to adjudicate.

Ensures that caseload is managed in compliance with applicable statutes, regulations, case law, and company standards. Follows guidance to optimize outcomes and to ensure claims are appropriately and timely addressed.

REQUIRED QUALIFICATIONS

EDUCATION: Minimum of High School diploma or equivalent certificate required. Bachelor’s degree from an accredited four-year university preferred.

EXPERIENCE: Minimum of three years of workers compensation indemnity claims adjusting experience, or an equivalent combination of education and industry experience, required.

CERTIFICATIONS: Maintains qualifying educational criteria for State of California to manage a caseload of workers compensation claims. Self-Insurance Administrators Certification preferred.

TECHNICAL AND COMPUTER SKILLS: (1) Strong California workers compensation indemnity claims management knowledge; (2) Moderate data analytic skills to perform solid data collection, analysis, and reporting; (3) Proficiency in Microsoft Office/365 suite of applications; (4) Knowledge of claims software systems and able to become proficient in proprietary and vendor software programs.

WHAT WE OFFER

Manageable Caseloads

Work-Life Balance

Modernized Historical Setting in East Sacramento

Free Lot Parking

BENEFITS

Paid Time Off

Paid Holidays

Retirements Savings Match

Group Health Insurance (Medical, Dental, and Vision)

Life and AD&D Insurance

Long Term Disability Insurance

Accident and Critical Illness Insurance

Flexible Savings Accounts

Paid Community Volunteer Day

Employee Assistance Program

Tuition Reimbursement Program

Employee Referral Program

Diversity, Equity and Inclusion Program