Technical Operator III

This is a fully remote position, open to applicants in California.

📋 Description

• Assess, negotiate, and resolve workers’ compensation claims in accordance with relevant laws and internal guidelines.

• Examine and evaluate medical invoices, treatment documentation, and claim files to establish suitable settlement amounts.

• Engage in negotiations with medical providers and other stakeholders to achieve equitable and prompt resolutions.

• Ensure adherence to applicable state workers’ compensation statutes and regulations.

• Keep precise and current records of negotiations and outcomes within the claims management system.

• Identify opportunities for cost savings and reduce claim liabilities.

• Communicate effectively and professionally with internal and external stakeholders.

• Analyze claims for trends and report any potential areas of concern.

• Collaborate closely with providers, adjusters, and internal teams.

⛳️ Requirements

• 2–5 years of experience in managing workers’ compensation claims, bill review, or negotiation (or an equivalent combination of education and experience).

• Comprehensive knowledge of workers’ compensation laws and fee schedules.

• Strong understanding of medical billing codes (CPT, ICD-10, HCPCS), state fee schedules, and PPO discounts.

• Exceptional written and verbal communication and negotiation abilities.

• Keen attention to detail and capability to handle multiple cases independently.

• Outstanding analytical skills.

• Ability to operate autonomously and manage various priorities in a fast-paced setting.

• Proficient in claims management systems and the Microsoft Office Suite.

• Experience in a Third Party Administrator (TPA), insurance carrier, or medical cost containment organization is preferred.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with company match.

• Opportunities for professional development and growth.

• Flexible work schedule and remote work options.