Claims Examiner Trainee (Spanish Fluency Preferred)

📋 Description

• Completes training on workers' comp claims handling, medical terms, and investigations.
• Investigates claims to determine coverage, compensability, and severity by phone.
• Calculates reserves for each claim and adjusts per authority guidelines.
• Develops and updates a Plan of Action for claim resolution.
• Makes timely decisions per guidelines; escalates red flags to supervisor.
• Ensures benefits due are calculated and issued per legal requirements.
• Collaborates with Call Center, Medical Management, Special Investigations, and Indemnity staff.

🎯 Requirements

• High School Diploma or equivalent; Bachelor's preferred.
• Effective verbal and written communication; Spanish fluency a plus.
• Solid interpersonal and customer service skills.
• Ability to manage and prioritize multiple assignments in a fast-paced environment.
• Strong organizational skills to meet hard deadlines.
• Proficient in Microsoft Office; able to learn databases and vendor software.

🎁 Benefits

• Full Training Program
• Growth and advancement opportunities
• Work–Life Balance
• Manageable caseloads
• Modernized East Sacramento setting
• Free lot parking