Claims Adjuster or Senior Claims Adjuster

Chesapeake Employers Insurance•Towson, MD

1d•Onsite

About The Position

This role involves independently investigating, evaluating, negotiating, settling, and adjusting claims in accordance with MD Workers’ Compensation Law and internal Guidelines. The Senior Claims Adjuster position also includes managing more complex claims and mentoring others. Responsibilities include reviewing data, determining coverage and compensability, setting reserves, negotiating settlements, documenting files, preparing for hearings, attending legal proceedings, and providing superior customer service. The role requires effective understanding of workers’ compensation claim handling, including average weekly wage calculation, disability ratings, reserves, and the impact of Medicare on claims. Continuous learning and professional development are expected.

Requirements

Bachelor’s degree and 2–4 years of industry-related experience or 5–8 years equivalent work experience including 3 years of workers’ compensation claims adjusting (Claims Adjuster).
Bachelor’s degree and 4-7 years of claims adjusting experience or 10 years equivalent work experience including 5 years of workers’ compensation claims adjusting (Senior Claims Adjuster).
Attainment of AIC certification or comparable certification in insurance (Claims Adjuster).
AIC designation or comparable designation (Senior Claims Adjuster).
Knowledge of claims basics including administrative procedures and processes, law, reserving, investigation, calculation of benefits, case management, fraud, subrogation, etc.
Must be a detail-oriented, flexible self-starter, with excellent written and verbal communication skills, capable of handling multiple tasks in a challenging environment.
Basic keyboarding and math skills (Senior Claims Adjuster).

Nice To Haves

Bilingual skills strongly preferred (Claims Adjuster).
Bilingual skills preferred (Senior Claims Adjuster).

Responsibilities

Independently investigate, evaluate, negotiate, settle and adjust claims in accordance with MD Workers’ Compensation Law and internal Guidelines.
Review all relevant data, evaluate claims, determine coverage & compensability, set reserves and negotiate settlement within settlement authority.
Document files with necessary reports, investigative notes, and other data.
Advise supervisor on status of problematic claims.
Prepare files for hearing, develop defense of issues, identify witnesses and make decisions regarding appeals.
Attend hearings, mediations, settlement conferences, pre-trial hearings and fraud trials.
Provide superior customer service to all internal and external stakeholders and the claims public.
Comply with standards for service and prompt contact.
Keep agents and policyholders informed of claim status as appropriate.
Anticipate and promptly respond to all issues and concerns.
Manage personal caseload effectively in accordance with claims standards and guidelines.
Demonstrate effective understanding of workers’ compensation claim handling to include evaluation and calculation of average weekly wage, disability ratings, reserves.
Demonstrate an understanding of the impact of Medicare on workers’ compensation claims to include Medicare Set-Asides and Conditional Payments.
Perform other duties as assigned.
Pursue continued education and professional development of industry knowledge.
Contribute to the achievement of established department goals and objectives; adhere to departmental policies, procedures, quality and safety standards, and consistently exhibit Chesapeake’s Values and Behaviors.
Manage more complex claims and mentor others (Senior Claims Adjuster).
Accompany less experienced personnel as requested (Senior Claims Adjuster).
Assist in the training, mentoring and development of less experienced staff (Senior Claims Adjuster).
Upon request, assume supervisory duties in supervisor’s absence (Senior Claims Adjuster).
Analyze and exhibit a higher level of understanding of claims financial exposure directly impacting the business (Senior Claims Adjuster).