Insurance Claims Coordinator jobs in Anaheim, CA

Insurance Claims Coordinator is responsible for coordinating and supporting initiatives relative to the evaluation, processing, and handling of insurance claims for an organization. Acts as a liaison between the organization, its insurance provider and agents, claimants, and policy holders regarding the status and eligibility for coverage for all relevant claims. Being an Insurance Claims Coordinator reviews claims to make sure that billing requirements are met, updates accounts as necessary, answers inquiries, and makes recommendations for resolution. Typically requires an associate degree or its equivalent. Additionally, Insurance Claims Coordinator typically reports to a manager. The Insurance Claims Coordinator gains or has attained full proficiency in a specific area of discipline. Works under moderate supervision. To be an Insurance Claims Coordinator typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)

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Claims Examiner III - temporary
  • Tristar Insurance
  • Chino, CA TEMPORARY
  • Job Details

    Level:    Experienced
    Job Location:    Chino Hills - Chino Hills, CA
    Position Type:    Temporary
    Education Level:    High School Diploma or GED
    Salary Range:    $93,600.00 - $104,000.00 Salary
    Travel Percentage:    None
    Job Shift:    Day
    Job Category:    Insurance

    Claims Examiner III temporary

    Please make sure that you complete all of the questions and navigate to the end of the application to sign the application.

     

    This is a remote position.

    This temp assignment runs through 6/30/2024.

     

    POSITION SUMMARY:  Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. 

     

    This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.

     

     

    DUTIES AND RESPONSIBILITIES:

     

    • Effectively manages a caseload of 150 to 200 workers’ compensation files, including very complex claims.*
    • Initiates and conducts investigation in a timely manner.*
    • Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.*
    • Manages medical treatment and medical billing, authorizing as appropriate.*
    • Refers cases to outside defense counsel.
    • Communicates with claimants, providers, and vendors regarding claims issues.
    • Computes and set reserves within Company guidelines.  Limits are larger than those allowed for Claims Examiner I and Claims Examiner II with changes authorized up to $1,000,000.
    • Settles and/or finalize all claims and obtains authority as designated.*
    • Maintains diary system for case review and documents file to reflect the status and work being performed on the file.*
    • Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.*
    • Adheres to all Company policies and procedures.*
    • Conducts file reviews as scheduled by the client and management.*
    • Other duties as assigned.

    * Essential job function.

    Qualifications


    Education/Experience:  Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.  

    Knowledge, Skills and Abilities:

    • Technical knowledge of statutory regulations and medical terminology.
    • Analytical skills.
    • Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
    • Ability to interact with persons at all levels in the business environment.
    • Ability to independently and effectively manage very complex claims.
    • Proficient in Word and Excel (preferred).

     

    Other Qualifications

    Certifications and/or licenses as required by State regulation.  Self-Insured Certificate a plus

    Here are some of the benefits that you can enjoy in this role:

    • Medical, Dental, Vision, Life Insurance & Disability
    • 401(k) plan
    • Referral bonus
    • Paid holidays
    • Paid time off.

    Mental and Physical Requirements:

     

               

                                 MENTAL AND PHYSICAL REQUIREMENTS

    1.  MENTAL EFFORT

     

    a.  Reasoning development:

     

              Follow one- or two-step instructions; routine, repetitive task.

     

              Carry out detail but uninvolved written or verbal instructions; deal with a few concrete                            variables.

     

              Follow written, verbal, or diagrammatic instructions; several concrete variables.

     

              Solve practical problems; variety of variables with limited standardization; interpret instructions.

     

     X      Logical or scientific thinking to solve problems; several abstract and concrete variables.

     

              Wide range of intellectual and practical problems; comprehend most obscure concepts.

    b.  Mathematical development:

     

              Simple additional and subtraction; copying figures, counting, and recording.

     

              Add, subtract, multiply, and divide whole numbers.

     

     X      Arithmetic calculations involving fractions, decimals, and percentages.

     

              Arithmetic, algebraic, and geometric calculations.

     

              Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.

     

              Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.

    c.       Language development:

     

              Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.

     

              Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.

     

              Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.

     

              Ability to compose original correspondence, follow technical manuals, and have increased contact with people.

     

     X       Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

    2.  PHYSICAL EFFORT

     

    a.       Physical activity required to perform the job:

     

     X       Sedentary work:  Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time.  Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

     

              Light work:

    a.    Exerting up to 20 pounds of force occasionally

    b.    Exerting up to 10 pounds frequently

    c.    Exerting a negligible amount of force constantly to move objects

     

              (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).

     

              Medium work:

    a.    Exerting up to 50 pounds of force occasionally

    b.    Exerting up to 20 pounds of force frequently

    c.    Exerting up to 10 pounds of force constantly to move objects

     

              Heavy work:

    a.    Exerting up to 100 pounds of force occasionally

    b.    Exerting up to 50 pounds of force frequently

    c.    Exerting up to 20 pounds of force constantly to move objects

     

              Very heavy work:

    a.    Exerting in excess of 100 pounds of force occasionally

    b.    Exerting in excess of 50 pounds of force constantly to move objects

    c.    Exerting in excess of 20 pounds of force constantly to move objects

     

        

    1. Visual requirements necessary to perform the job:

     

              Far vision:  clarity of vision at 20 feet or more

     

     X      Near vision:  clarity of vision at 20 inches or less

     

     X      Mid-range vision:  clarity of vision at distances of more than 20 inches and less than 20 feet

     

              Depth perception:  the ability to judge distance and space relationships, so as to see objects where and as they actually are

     

              Color vision:  ability to identify and distinguish colors

     

              Field of vision:  ability to observe an area up or down or to the right or left while eyes are fixed on a given point

     

     

     

    2.  PHYSICAL EFFORT (cont.)

        FREQUENCY

    c.        Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):

     

           Climbing:      Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms.  Body agility is emphasized.  This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.

     

           Balancing:     Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces.  This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.

     

           Stooping:       Bending body downward and forward by bending spine at the waist.  This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.

     

           Kneeling:       Bending legs at knee to come to a rest on knee or knees.

     

           Crouching:    Bending the body downward and forward by bending legs and spine.

     

           Crawling:      Moving about on hands and knees or hands and feet.

     

           Reaching:      Extending hand(s) and arm(s) in any direction.

     

            Standing:       Particularly for sustained periods of time.

     

           Walking:       Moving about on foot to accomplish tasks, particularly for long distances.

     

           Pushing:        Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.

     

           Pulling:         Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.

     

           Foot

           Motion:          Using feet to push pedals.

     

           Lifting:          Raising objects from a lower to a higher position or moving objects horizontally from position to position.  This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.

     

     X    Fingering:     Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.

     

     X    Grasping:      Applying pressure to an object with the fingers and palm.

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Frequently

     

     

    Occasionally

     

     

     

     

    2.  PHYSICAL EFFORT (cont.)                  

          FREQUENCY

     X    Talking:         Expressing or exchanging ideas by means of the spoken word.  Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

     

     X    Hearing:        Perceiving the nature of sounds with or without correction.  Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making find adjustments on machined parts.

     

           Feeling:         Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.

     

     X    Repetitive      Substantial movements (motions) of the wrists, hands,

           Motion:         and/or fingers.

    Frequently

     

     

     

    Frequently

     

     

     

     

     

     

     

    Frequently

     

     

    3.  WORKING CONDITIONS

     

    Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. 

     

           WORKING CONDITION

               ENVIRONMENTAL

                         FACTOR

               NATURE/REASON

                   OF EXPOSURE

     

                    FREQUENCY

    Dirt/Dust

     

     

    Noise

     

     

    Temperature extremes

     

     

    Dampness

     

     

    Vibrations

     

     

    Equipment movement hazard

     

     

    Chemicals/solvents

     

     

    Electrical shock

     

     

    Significant work pace/pressure

     

     

    Odors/Fumes

     

     

    Other (specify):                              

     

                                                             

     

     

           

     

     

  • 1 Day Ago

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Agency Coordinator
  • Combined Insurance
  • Anaheim, CA FULL_TIME
  • POSITION SUMMARY The Agency Coordinator (AC) is primarily responsible for prospecting new customers independently and meeting with current customers to sell Insurance products within a specific geogra...
  • Just Posted

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Freight Forwarder Claims Coordinator
  • OEC Group
  • Cerritos, CA FULL_TIME
  • We offer competitive salary, full benefits package, Paid Time Off, and opportunities for professional growth.Established in 1981, Orient Express Container (OEC) Group is one of the top freight forward...
  • 15 Days Ago

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Logistics Claims Coordinator
  • OEC Group
  • Cerritos, CA FULL_TIME
  • We offer competitive salary, full benefits package, Paid Time Off, and opportunities for professional growth.Established in 1981, Orient Express Container (OEC) Group is one of the top freight forward...
  • 2 Months Ago

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Independent Insurance Claims Adjuster in San Dimas, California
  • MileHigh Adjusters Houston Inc
  • San Dimas, CA FULL_TIME
  • ADJUSTERS NEEDED NOW!ADJUSTERS NEEDED NOW FOR ALL STORM RELATED SEASONS!Independent Insurance Claims Adjusters Needed Now! This is a HUGE opportunity for you, since there is currently a HIGH DEMAND fo...
  • 18 Days Ago

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Independent Insurance Claims Adjuster in Stanton, California
  • MileHigh Adjusters Houston Inc
  • Stanton, CA FULL_TIME
  • ADJUSTERS NEEDED NOW!ADJUSTERS NEEDED NOW FOR ALL STORM RELATED SEASONS!Independent Insurance Claims Adjusters Needed Now! This is a HUGE opportunity for you, since there is currently a HIGH DEMAND fo...
  • 19 Days Ago

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0 Insurance Claims Coordinator jobs found in Anaheim, CA area

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Personal Injury Case Manager (Work from Home)
  • TORKLAW
  • Irvine, CA
  • Are you one of those special people who can take direction from others and successfully lead a small team to achieve the...
  • 4/16/2024 12:00:00 AM

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Bilingual Personal Injury Case Manager (Work from Home)
  • TORKLAW
  • Irvine, CA
  • Are you one of those special people who can take direction from others and successfully lead a small team to achieve the...
  • 4/15/2024 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...
  • 4/15/2024 12:00:00 AM

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Workers' Compensation Claim Adjuster (Remote) (California Claims)
  • CCMSI
  • Irvine, CA
  • Overview: At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Part...
  • 4/14/2024 12:00:00 AM

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Office Manager - Carson Honda
  • Sonic Automotive
  • Carson, CA
  • Company Description At Carson Honda Honda, a Sonic Automotive family dealership, you'll find the opportunities, resource...
  • 4/13/2024 12:00:00 AM

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Managed Care Claims Assistant I
  • AmTrust Financial Services, Inc.
  • Irvine, CA
  • Overview AmTrust Financial Services, a fast-growing commercial insurance company, has an opportunity for a Claim Assista...
  • 4/13/2024 12:00:00 AM

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Claim Supervisor Property & Casualty
  • Western Mutual Insurance Group
  • Irvine, CA
  • Job Description Job Description We have an immediate opening for an experienced Property Claim Supervisor. Candidate mus...
  • 4/13/2024 12:00:00 AM

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Insurance Repair Project Manager
  • Bartwood Construction, Inc.
  • Irvine, CA
  • " Company Description Bartwood Construction, Inc. has been a premier leader in the insurance restoration industry for ov...
  • 4/12/2024 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 Insurance Claims Coordinator jobs
$54,812 to $83,231
Anaheim, California area prices
were up 3.2% from a year ago

Insurance Claims Coordinator in Wilmington, DE
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Insurance Claims Coordinator in Bellingham, WA
This individual will review all claims and make coverage decision.
January 31, 2020