Senior Claims Adjuster (Workers Compensation)

BlueCross BlueShield of South Carolina•Columbia, SC

1d•Remote

About The Position

Independently investigates, evaluates, and negotiates the resolution of assigned claims within approved authority. Responsible for making recommendations for claim outcomes on claims exceeding level of authority. This is a full-time position, with a Remote schedule, working an 8-hr. shift (40-hours/week) Monday-Friday 8:00am – 5:00pm with primary location at 17 Technology Circle Columbia SC, Columbia, SC 29203. Due to initial training period and some on-site activities, qualified, local candidates need apply.

Requirements

Bachelor's degree (see degree equivalency below)
4 years job related work experience or Associate's and 2 years job related work experience.
4 years of area related adjusting experience.
Ability to analyze laws, regulations and contract language.
Ability to evaluate issues and develop recommendations.
Ability to handle confidential and sensitive information.
Ability to investigate assigned claims and propose claims adjustments and refunds.
Strong verbal and written communication skills.
Strong interpersonal skills.
Microsoft Office.
Valid adjuster's license in required states or ability to acquire within 6 months-if required by resident state's department of insurance.

Nice To Haves

Strong organizational skills.
Solid ability and experience navigating multiple systems.
Able to work independently.
Able to manage distractions effectively.
Strong communication skills, both verbally and written.

Responsibilities

Using advanced subject matter expertise; conduct investigations of assigned claims (workers comp, first and third party property, general liability or auto physical damage) in adherence with corporate timeliness and quality performance standards.
Some claims may require in-person investigation/contact with an independent adjusting firm, accident reconstruction by an engineering firm and/or legal research with or without utilization of counsel.
Manage (catastrophic, high exposure and complexity) caseload to ensure proactive disability, medical management and timely response to treatment recommendations, ongoing contact with the injured and insured, and a 100% closing ratio.
Provide direction and possible training to less experienced adjustors on less complex cases as needed.
Document activities, case action plans, settlements evaluations and requests for authorizations in the claim notes.
Provide management and internal and external customers with documentation to support recommendations and claim status as required.
Direct litigation process and work with attorneys to establish defense strategy and case legal budget.
Negotiate settlements directly with claimants or opposing counsel.
May require attendance or testimony at hearings, trials, or mediations.
Evaluate specials, damages, and/or extent of disability and negotiate settlements with individuals and/or attorneys.
Utilize independent adjustors to assist in the evaluation of liability and for damages and reports findings.
Reviews independent adjustor's reports and handles claim outcome.