Sutter Health Claims Administrator (Claims Adjuster) in Sacramento, California

Description

The Claims Administrator is responsible for the management of workers' compensation claims for assigned self-insured Affiliates. Individual must be able to manage claims from time reported until resolution. Must be able to work in a team environment with technical specialists, supervisor, claim manager and Affiliate representatives. Must also be able to partner with medical providers, and Risk Management professionals to ensure integration of claim issues.

Qualifications

Education

HS Diploma Required

Bachelor's Preferred Or equivalent education/experience

Licensure

Individual must be willing to prepare and take the SIP Certificate exam within 36 months. Required

Successful completion of an IEA Certificate or the equivalent is required within 18 months of incumbency. 1 1/2 Yrs Required

Driver License, Valid and in State - DL NUMBER Required

Automobile Insurance - INSURANCE Required

Experience

3-5 years Must be able to demonstrate a thorough knowledge of California Workers’ Compensation law required.

3-5 years Must have on the job and classroom training, experience and knowledge surrounding California’s Labor Code, estimating workers’ compensation costs, permanent disability rating and medical terminology required.

Skills and knowledge

Significant prior claims payment/adjudication experience in workers’ compensation is required.

Proven oral and written communication skills are essential.

Communications must reflect knowledge of grammar in English composition and acceptable business letter format, as well as, industry jargon.

Demonstrated ability to handle confidential information is required.

Experience with a claim payment system is desired.

Knowledge of medical terminology, as well as, mathematical skills and a Self-Insurance Certification is preferred.

Must ensure compliance with Standard Work and Claims Management Standards.

Must have the ability to work independently, maintain a balance of work priorities and complete assignments within established timeframes.

Excellent analytical skills, the ability to draw valid conclusions, and formulate sound recommendations is required.

Organizational and planning skills are required, as well as, the ability to manage and coordinate the activities related to the payment of workers’ compensation claims.

Ability to work with diverse health and administrative professionals at all organizational levels.

Must be computer literate and have a working knowledge of Microsoft Office.

Must be able to use all general office equipment.

Organizational and planning skills are required, as well as, the ability to manage and coordinate the activities related to an assigned caseload

Valid drivers’ license is required to ensure the ability to travel to client locations, WCAB hearings, rehabilitation conferences (formal and informal), professional development seminars, etc.

Ability to communicate effectively both written and orally.

Primary Location: California, Greater Sacramento Area, Sacramento

Organization: Sutter Health System Office

Employee Status: Regular

Benefits: Yes

Position Status: Exempt

Union: No

Job Shift: Day

Shift Hours: 8 Hour Shift

Days of the Week Scheduled: Monday-Friday

Weekend Requirements: None

Schedule: Full Time

Hrs Per 2wk Pay Period: 80

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.