Claims Clerk jobs in Anaheim, CA

Claims Clerk reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Being a Claims Clerk verifies coverage eligibility. Calculates settlement amounts according to guidelines. Additionally, Claims Clerk processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. The Claims Clerk works under the close direction of senior personnel in the functional area. Possesses a moderate understanding of general aspects of the job. May require 0-1 year of general work experience. (Copyright 2024 Salary.com)

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Claims Examiner - Workers Compensation (Hybrid Opportunity!)
  • Sedgwick Claims Management Services Inc.
  • Brea, CA FULL_TIME
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work® Most Loved Workplace® Forbes Best-in-State Employer Claims Examiner - Workers Compensation (Hybrid Opportunity!) HYBRID WORK SCHEDULE - ONE DAY IN OFFICE, BREA CA PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within designated authority. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. Prepares necessary state fillings within statutory limits. Manages the litigation process; ensures timely and cost effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. 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, travel as required Auditory/Visual: Hearing, vision and talking NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000 - $100,000 per year. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles. Taking care of people is at the heart of everything we do. Caring counts Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us.
  • 5 Days Ago

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CA - Field Representative
  • Hancock Claims Consultants
  • Anaheim, CA FULL_TIME
  • With a 20-year history supporting property insurers, Hancock Claims Consultants provides a nationwide network of inspectors, contractors, and engineers who help adjusters quickly process claims. All 5...
  • 24 Days Ago

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Claims Specialist
  • Pilot Air Freight, LLC
  • Brea, CA FULL_TIME
  • About Us: As a company, we promote a culture of honesty and integrity, and value the trust it allows us to build with customers and employees alike. Our focus on our people is what sets us apart and k...
  • 20 Days Ago

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Claims Specialist
  • Maersk Agency USA, Inc.
  • Brea, CA FULL_TIME
  • About Us:As a company, we promote a culture of honesty and integrity, and value the trust it allows us to build with customers and employees alike. Our focus on our people is what sets us apart and ke...
  • Just Posted

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Claims Processor
  • Ultimate
  • Brea, CA FULL_TIME
  • Job Description Responsibilities BASIC JOB PURPOSE: Under the supervision of the Claims Manager or designee, claims processors are responsible for accurately and efficiently entering and processing cl...
  • 1 Day Ago

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Claims Manager
  • Ultimate
  • Diamond, CA FULL_TIME
  • Job Description Responsibilities/Duties:Provide an environment that allows staff members to flourish in their work duties. Quality levels of 99% maintained throughout the department.Continuous trainin...
  • 1 Day Ago

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0 Claims Clerk jobs found in Anaheim, CA area

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Property Damage Specialist - AUTOMOTIVE SERVICE EXPERIENCE
  • Dynamic Claims Administrative Services, LLC.
  • Irvine, CA
  • Job Description Job Description Dynamic Claims Administrative Services, LLC. a National adjusting company, is seeking an...
  • 3/29/2024 12:00:00 AM

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Workers' Compensation Claims Adjuster
  • AdminSure Inc
  • Ontario, CA
  • Job Description Job Description Essential Job Functions and Responsibilities: Proven ability to meet industry claims adm...
  • 3/29/2024 12:00:00 AM

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HQ Customer Service Rep - Santa Ana
  • Turner Construction Co
  • Santa Ana, CA
  • **Project Location(s):** Santa Ana, CA 92707 USA **Minimum Years Experience:** 4**Education:**Bachelors Degree**Compensa...
  • 3/29/2024 12:00:00 AM

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Claims Administrator
  • Randstad Enterprise
  • Laguna Hills, CA
  • Currently hiring for a Claims Administrator for our client located in Laguna Hills, CA. This is a HYBRID, full time, tem...
  • 3/28/2024 12:00:00 AM

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Claims Administrator
  • Synkriom
  • Laguna Hills, CA
  • Job Description Job Description JOB DETAILS: Semi manual DMHO claims adjudication using our in-house claim system. MS Ex...
  • 3/28/2024 12:00:00 AM

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Claims Administrator || Full Remote ( Only 2 weeks office Training )
  • Synkriom
  • Laguna Hills, CA
  • Job Description Job Description They are okay with full remote candidate; however, they would like them to spend at leas...
  • 3/27/2024 12:00:00 AM

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Professional Liability Adjuster
  • Dynamic Claims Administrative Services, LLC.
  • Irvine, CA
  • Job Description Job Description Professional Liability Adjuster Classification: Exempt Pay Type: Salary Reports to: Clai...
  • 3/27/2024 12:00:00 AM

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Sr. Claims Representative- Bilingual
  • BITCO INSURANCE COMPANIES
  • Pasadena, CA
  • Job Description BITCO Corporation, headquartered in Davenport, IA, is currently seeking aBilingualSr. Claims Representat...
  • 3/27/2024 12:00:00 AM

Anaheim (/ˈænəhaɪm/) is a city in Orange County, California, part of the Los Angeles metropolitan area. As of the 2010 United States Census, the city had a population of 336,265, making it the most populous city in Orange County and the 10th-most populous city in California. Anaheim is the second-largest city in Orange County in terms of land area, and is known for being the home of the Disneyland Resort, the Anaheim Convention Center, and two major sports teams: the Anaheim Ducks ice hockey club and the Los Angeles Angels baseball team. Anaheim was founded by fifty German families in 1857 and...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Clerk jobs
$40,771 to $51,586
Anaheim, California area prices
were up 3.2% from a year ago