Role Description Our client is seeking to add a California Workers Compensation Claims Examiner to their Southern California branch. This role will consist of handling California Workers Compensation Lost Time claims from inception to close. Qualified candidates must possess a strong knowledge in California Law, and SIP is strongly preferred. This is a Temporary-to-Hire position with the ability to work remotely. - Handle moderate to complex California Workers Compensation claims with minimal supervision and guidance from the manager. - Manage medical treatment and medical billing when appropriate. - Negotiate settlements with injured workers and attorneys. - Consistently exhibit a high level of customer service and adherence to department Best Practices. Qualifications - 2 - 5+ years of experience handling Workers Compensation claims. - Must be well-versed in California Workers Compensation Law. - Must have experience handling litigated files. - Excellent Customer Service and Organizational skills. - High School Diploma; Bachelor's Degree preferred but not required. Requirements - 2 - 5+ years of experience handling Workers Compensation claims. - Must be well-versed in California Workers Compensation Law. - Must have experience handling litigated files. - Excellent Customer Service and Organizational skills. - High School Diploma; Bachelor's Degree preferred but not required. Benefits - $40.00/hr to $50.00/hr - Competitive Medical, Dental, and Vision Benefits while on assignment. - Opportunity to transition to permanent employee. - Flex schedule and ability to work remotely.

• Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. • Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios. • Ensure prompt claims processing to meet client standards and regulatory requirements. • Identify and resolve any barriers using effective problem-solving strategies. • Collaborate with internal departments to proactively resolve discrepancies and issues. • Use analytical skills to identify root causes and implement solutions. • Uphold confidentiality of patient records and company information in accordance with HIPAA regulations. • Maintain thorough and accurate records of claims processed, denied, or requiring further investigation. • Analyze and report trends in claim issues or irregularities to management. • Assist Team Leads with reporting to contribute to continuous process improvements. • Engage in audits and compliance reviews to ensure adherence to internal and external regulations. • Critically evaluate and recommend process improvements when necessary. • Mentor and train new claims processors as needed.

• Investigate, negotiate, and resolve/settle assigned claims • Oversee vendor and legal activities • Maintain file notes and action plans • Manage loss severity through medical cost management

Title: Prior Authorization Specialist - MRI Location: West Des Moines, Ankeny Iowa, 50266, United States Department: Administrative Support Requisition Number: PATIE002296 Full-Time Job Description: A rare opportunity to assist with obtaining insurance approval for patient MRI scans is available at Des Moines Orthopaedic Surgeons, P.C. We are seeking individuals with prior experience submitting prior authorizations to insurance companies for advanced imaging and/or experience working with insurance company websites. As a Prior Authorization Specialist with our MRI department you will submit prior authorization via insurance company websites, follow up on status, and assist with scheduling MRI scans upon approval. You will work alongside 3 other individuals to assist our patients in a timely fashion. This is a full-time (40-hrs) opportunity, with Monday - Friday Here is What You Can Expect: - Specializing in advanced imaging authorization and appointment scheduling for our MRI department (West Des Moines and Ankeny locations). - Utilizing Office 365 products to organize MRI schedules, insurance prior authorizations and communicating with clinical staff when needed. - Sitting at a desk for extended periods of time that may seem unnatural. - Work from home available after training is complete What We're Looking For: - Professional. Display a high-level of professionalism when interacting with patients and clinical staff members. - Multi-tasker. Ability to handle multiple tasks at one time while staying organized. - Curiosity. You practice the art of listening, asking clarifying questions and avoiding interrupting. - Experience. Prior exposure to patient care coordination. - Dependability. Ensures patients receive timely care, promotes a reliable healthcare environment, and supports the overall efficiency of the team. Why DMOS? - Consistent schedule, no weekend coverage - Friendly, fun and dedicated peers - Outstanding 401(k) with employer match and an annual company profit sharing contribution (even if you don't participate in the employer match) - Health, dental, and vision insurance including 6 paid holidays and a generous PTO accrual program (as a full-time employee you can anticipate to earn up to 22 days per year) Join our team of orthopaedic surgeons and discover how your talents will change lives helping our patients get back to living! DMOS is a privately held medical facility. Candidates who receive a conditional offer of employment at DMOS will be required to complete a criminal background check, federal background checks, education verification, reference checks, and an initial TB test. Qualifications Education Required: H.S. GED or Diploma or better in General. Experience Preferred 1 year: Medical Reception or Coordination