Senior Workers Compensation Adjuster - Remote CST/EST

Charles Taylor

1d•Remote

About The Position

Charles Taylor is seeking a highly experienced Senior Workers’ Compensation Adjuster to join their Third-Party Administration team. This is a remote role for CST/EST time zones. The Workers Compensation Claims Adjuster is responsible for managing all aspects of a State Act workers compensation claim, including determining compensability, verifying coverage, administering disability and medical benefits, negotiating claim resolutions, and assisting injured employees, employers, and medical/legal professionals with service needs throughout the claim's lifespan.

Requirements

5-10 years experience handling high level claims
Experience and current adjusters license to handle WC claims in AR, DC, IL, LA, MN, NJ, SC, TN, TX, WI
High School education
Proficiency in entire Microsoft Office suite
Knowledge of relevant workers’ compensation laws
Strong grasp of medical terminology
Familiarity with medical cases and how treatment typically progresses
Excellent professional oral and written communication abilities
Attention to detail and good organization skills
Ability to negotiate issues and settlements
Strong focus on customer service which includes timely response to requests/inquiries
Ability to adapt to changing technologies and learn functionality of new equipment and systems
Ability to establish and maintain effective working relationships with others

Responsibilities

Receives newly reported claims
Determines coverage under the State WC Act, and any exposure to LHWCA
Maintains and updates claim notes throughout the lifespan of the claim
Records claim information in an electronic database
Interviews claimants, insureds, medical professionals, and witnesses to determine claim validity
Communicates claim compensability decisions to claimant, employer, and medical provider
Sets appropriate reserves based on the nature and extent of the injury
Calculates lost time wages and makes disability payments directly to claimants, diarizing future payments as appropriate
Reports all mandatory claims data directly to State entities within required timeframes
Orders independent medical examinations as necessary and prepares all relevant documentation for physician review
Maintains regular correspondence with claimants, insureds, clients, and nurse case managers, including claim updates, medical appointments, or issues with disability payments
Reviews and processes medical bills for additional discount opportunities
Aggressively collaborates with claimants, clients, and insureds to ensure early return-to-work is pursued
Works in partnership with legal counsel to ensure insured’s interests are protected on litigated claims, providing all relevant claim documentation needed for defense counsel to successfully defend the claim and evaluate ultimate claim exposure
Attends settlement conferences, mediations, and hearings on behalf of the insurance company
Reviews and approves defense attorney bills within authority
Works with underwriting to provide relevant information on losses for renewal rates, as well as Risk Management to identify trends. May also interact with agents for insureds on losses
Responds to State requests for health cost disputes, applications for hearings, and penalty assessment letters
Identifies subrogation potential and pursues recovery
Leads claim reviews with clients as requested