Senior Claims Adjuster (State)

Chesapeake Employers Insurance•Towson, MD

1d•$69,780 - $104,670

About The Position

Sr. Claims Adjuster POSITION SUMMARY:Independently investigate, evaluate, negotiate, settle and adjust claims in accordance with MD Workers’ Compensation Law and internal Guidelines, manage more complex claims and mentor others. DUTIES AND RESPONSIBILITIES: Independently investigates claims, following sound claims handling techniques in accordance with company claim philosophy and quality assurance standards, and in accordance with the Maryland Compensation Law. Reviews all relevant data, evaluates claims, determines coverage and compensability and negotiates within settlement authority. Documents files with necessary reports, investigative notes, and other data may be required by the Maryland Workers’ Compensation Law, the company and the unit supervisor. Advise supervisor on status of problematic claims. Prepares files for hearing, develops defense of issues, identifies witnesses and makes decisions regarding appeals. Attends hearings, mediations, settlement conferences, pre-trial hearings and fraud trials for assigned files, and accompanies less experienced personnel as requested. Assists in the training, mentoring and development of less experienced staff and, upon request, assumes supervisory duties in supervisor’s absence. Provide 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 independently and effectively in accordance with claims standards and guidelines, demonstrating the ability to handle cases of various levels of complexity. Demonstrates effective understanding of worker compensation claim handling to include evaluation and calculation of average weekly wage, disability ratings, and reserves. Analyze and exhibit a higher level of understanding of claims financial exposure directly impacting the business. Demonstrates an understanding of the impact of Medicare on workers compensation claims to include Medicare-Set Asides and Conditional payments. Performs other duties as may be dictated by department circumstances.

Requirements

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 and AIC designation or comparable designation.
Basic keyboarding and math skills.
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 preferred.

Responsibilities

Independently investigates claims, following sound claims handling techniques in accordance with company claim philosophy and quality assurance standards, and in accordance with the Maryland Compensation Law.
Reviews all relevant data, evaluates claims, determines coverage and compensability and negotiates within settlement authority.
Documents files with necessary reports, investigative notes, and other data may be required by the Maryland Workers’ Compensation Law, the company and the unit supervisor.
Advise supervisor on status of problematic claims.
Prepares files for hearing, develops defense of issues, identifies witnesses and makes decisions regarding appeals.
Attends hearings, mediations, settlement conferences, pre-trial hearings and fraud trials for assigned files, and accompanies less experienced personnel as requested.
Assists in the training, mentoring and development of less experienced staff and, upon request, assumes supervisory duties in supervisor’s absence.
Provide 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 independently and effectively in accordance with claims standards and guidelines, demonstrating the ability to handle cases of various levels of complexity.
Demonstrates effective understanding of worker compensation claim handling to include evaluation and calculation of average weekly wage, disability ratings, and reserves.
Analyze and exhibit a higher level of understanding of claims financial exposure directly impacting the business.
Demonstrates an understanding of the impact of Medicare on workers compensation claims to include Medicare-Set Asides and Conditional payments.
Performs other duties as may be dictated by department circumstances.