Workers’ Compensation Indemnity Examiner

We are in search of a Workers’ Compensation Indemnity Examiner to join our team in the industry of workers' compensation claims based in Roseville, California. This role offers a long-term contract employment opportunity where you will be tasked with preparing for PAR audits, verifying Medicare coding, and handling low complexity claims.

• Assist in the preparation of PAR audits by reviewing claims in our system for the timeliness of benefit payments and benefit notices.
• Calculate the average weekly wage, TTD, and TPD.
• Verify the accuracy of Medicare coding in claims.
• Handle low complexity claims including contacting employers, claimants, and physicians.
• Evaluate and determine compensability of claims, authorizing medical treatment as appropriate.
• Review and obtain medical records, updating information in our claims management system.
• Adjust claim reserves as needed, including setting and adjusting reserves.
• Make appropriate UR referrals and monitor UR time frames.
• Review and respond to incoming mail, emails, and faxes, entering detailed claim notes in the system.
• Prepare various types of correspondence. • Demonstrated proficiency in CRM and EHR SYSTEM software
• Experience in handling appeals related to workers' compensation claims
• Strong understanding of benefit functions, billing functions, and claim administration
• Knowledge of Medicare claim processing and indemnity insurance
• Experience in medical coding relevant to workers’ compensation
• Ability to work in a team-oriented environment and manage multiple tasks concurrently
• Strong communication skills, both written and verbal
• High level of attention to detail and organizational skills
• Bachelor’s degree in Business Administration, Law or a related field is preferred
• Prior experience in a similar role or in the insurance industry is advantageous.