Medical Claims Specialist - Workers Compensation

{
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  "source_hash": "7bdf5344021e142eab3c64be91056af5a6973758b38dee0403f9e23e55b5e664",
  "last_changed_at": "2026-05-29T07:01:45.032Z",
  "active_status": "active"
}

{
  "language": "en",
  "location": {
    "raw": "San Diego, California",
    "city": "San Diego",
    "region": "CA",
    "country": "United States",
    "is_remote": false,
    "confidence": 0.85
  },
  "salary_max": null,
  "salary_min": null,
  "inferred_at": "2026-06-06T07:57:32.118Z",
  "launch_scope": {
    "reason": "english_us_canada",
    "included": true,
    "language": "en",
    "location": {
      "raw": "San Diego, California",
      "city": "San Diego",
      "region": "CA",
      "country": "United States",
      "is_remote": false,
      "confidence": 0.85
    },
    "countries": [
      "United States"
    ]
  },
  "remote_policy": "hybrid",
  "salary_period": null,
  "workplace_type": "hybrid",
  "salary_currency": null
}

{}

{
  "lists": [
    {
      "text": "ESSENTIAL RESPONSIBILITIES",
      "content": "\n<li>Successfully completes the Medical Claims Training Program.</li>\n<li>In classroom training, is attentive, takes notes, asks appropriate questions, participates successfully in exercises, and demonstrates mastery of the subject material.</li>\n<li>In the Medical Claims Unit, asks appropriate questions, exhibits continuous improvement under the guidance of the supervisor, and demonstrates mastery of fundamental adjusting knowledge, skills, and strategy.</li>\n<li>Learns medical subjects including anatomy, physiology, terminology, pharmacology, causation, nature of the injury, and diagnostic and treatment methodology.</li>\n<li>Learns legal subjects including relevant statutes and regulations.</li>\n<li>Learns to effectively and efficiently use the computer systems employed in the management of claims.</li>\n<li>Learns skills such as investigative and persuasive communication, decision-making, and documentation.</li>\n<li>For clients who are provided with a dedicated Claims Medical Specialist, establishes and maintains a sound working and communication relationship with the client’s contact personnel.</li>\n<li>Determines coverage for new claims.</li>\n<li>Conducts and directs the investigation of new claims to determine compensability and severity and to gather all other relevant information.</li>\n<li>Calculates appropriate reserves and ensures that reserves are adjusted as needed.</li>\n<li>Ensures that benefits are provided in accordance with the law and that the claim as a whole is managed in accordance with all legal requirements including the issuance of appropriate notices and filings.</li>\n<li>Manages each claim to an appropriate and successful resolution.</li>\n<li>Ensures that work is performed in accordance with Company procedures, standards, training, and supervisory direction.</li>\n<li>Fosters a positive and close working relationship with other Company staff, including the Call Center, Medical Management teams, Client Services, and indemnity Adjusting staff.</li>\n"
    },
    {
      "text": "REQUIRED QUALIFICATIONS",
      "content": "\n<li>EDUCATION: Minimum of High School Diploma or equivalent certificate required.</li>\n<li>EXPERIENCE: Administrative experience in the areas of law, medicine, insurance/workers compensation, telephonic communication, or negotiation is useful but not necessary.</li>\n<li>REASONING ABILITY: Able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.&nbsp; Able to deal with problems involving several concrete variables in standardized situations.</li>\n<li>COMPUTER SKILLS: Able to effectively use Microsoft Office Suite applications. Able to quickly master proprietary and vended software applications.</li>\n"
    },
    {
      "text": "WHAT WE OFFER",
      "content": "\n<li>Manageable Caseloads</li>\n<li>Work-Life Balance</li>\n<li>Work From Home Program (up to 2 days per week)</li>\n<li>Free On-Site Fitness Facility</li>\n<li>Free On-Site Garage Parking</li>\n"
    },
    {
      "text": "BENEFITS",
      "content": "\n<li>Paid Time Off</li>\n<li>Paid Holidays</li>\n<li>Retirements Savings Match</li>\n<li>Group Health Insurance (Medical, Dental, and Vision)</li>\n<li>Life and AD&amp;D Insurance</li>\n<li>Long Term Disability Insurance</li>\n<li>Paid Community Volunteer Day</li>\n<li>Employee Assistance Program</li>\n<li>Tuition Reimbursement Program</li>\n<li>Employee Referral Program</li>\n<li>Diversity, Equity and Inclusion Program</li>\n"
    }
  ],
  "country": "US",
  "createdAt": 1737046133517,
  "updatedAt": null,
  "categories": {
    "team": "Southern CA",
    "location": "San Diego, California",
    "commitment": "Non-Exempt",
    "department": "Claims Adjusting",
    "allLocations": [
      "San Diego, California"
    ]
  },
  "salaryRange": null,
  "workplaceType": "hybrid"
}