Claims Adjuster or Sr. Claims Adjuster

Chesapeake Employers Insurance•Towson, MD

2d•Onsite

About The Position

Independently investigate, evaluate, negotiate, settle, and adjust claims in accordance with Maryland Workers’ Compensation Law and internal guidelines.

Requirements

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

Nice To Haves

Bilingual skills strongly preferred.

Responsibilities

Independently investigates assigned claims, following sound claims handling techniques in accordance with company claim philosophy and quality assurance standards, and in accordance with Maryland Compensation Law.
With limited assistance from unit supervisor, reviews all relevant data, evaluates claims, determines coverage and compensability, sets reserves, and negotiates settlements within settlement authority.
Documents files with necessary reports, investigative notes, and other data as may be required by Maryland Workers’ Compensation Law, the company, and the unit supervisor.
Advises supervisor on the status of problematic claims.
Prepares files for hearings, develops defenses for issues, identifies witnesses, and makes decisions regarding appeals.
Attends hearings, mediations, settlement conferences, pre-trial hearings, and fraud trials.
Provides superior customer service to all internal and external stakeholders and the claims public.
Complies with standards for service and prompt contact.
Keeps agents and policyholders informed of claim status as appropriate.
Anticipates and promptly responds to all issues and concerns.
Manages personal caseload effectively in accordance with claims standards and guidelines and demonstrates the ability to learn, develop, and manage complex cases.
Demonstrates effective understanding of workers’ compensation claim handling, including evaluation and calculation of average weekly wage, disability ratings, and reserves.
Demonstrates an understanding of the impact of Medicare on workers’ compensation claims, including Medicare Set-Asides and conditional payments.
Performs other duties as assigned.
Pursues continued education and professional development of industry knowledge.
Contributes to the achievement of established department goals and objectives; adheres to departmental policies, procedures, quality, and safety standards; and consistently exhibits Chesapeake’s Values and Behaviors.