Senior Workers' Compensation Lost Time Claims Adjuster

RH Wine & Co LLC•St. Charles, IL

5d•$85,000 - $90,000

About The Position

Are you a driven, ambitious, and energetic professional looking for your next challenge? Join Insurance Program Managers Group (IPMG) and become part of a dynamic team committed to innovation! For the past 27 years, our mission has been to create one-of-a-kind solutions for our partners. We bring proactive and tailored approaches to our clients, valuing the unique contribution of each team member. Together, we shape our identity and drive transformative change for our clients. We are looking for a workers' compensation lost time adjuster. This role is a full-time, exempt position who performs technical work on intermediate to complex workers’ compensation with lost time and litigated claims.

Requirements

At least 5 years of adjuster experience
Knowledge of common software programs such as Microsoft Office and Excel
Excellent verbal and written communication skills
Great customer service skills

Responsibilities

Follows defined processes, quality standards and procedures are followed.
Ensure contact with insured, claimant, witnesses, doctors and other parties are secured and obtain details about the loss and properly investigate if claims are compensable while using investigative approach in decision making for approval or denial.
Reviews all new claims within 1-2 business days.
Reviews claim related correspondences and determine appropriate actions are made.
Maintains files notes in accordance with established procedures, maintains timely diary management, updates accurate coding and claim closing goals.
Provides timely and proactive information to clients, claimants, insureds, and others regarding the status of claims.
Recognizes clients that participate in occupational health structures with compliance to their respective special protocols.
Sets initial and on-going reserves for incurred costs and authorizes or denies payments based on facts of the claim.
Ensures subrogation opportunities are consistently identified and executed with correct outline for accurate recovery.
Draft coverage letters and discuss outcomes with clients and agents proactively before letter is sent.
Properly evaluate exposure report to excess carriers and reinsurers accordingly
Roundtable claims with management and counsel, as needed.
Efficiently manage vendor related costs while assigning the correct vendor based on service need.
Maintain current weekly diary with limited overdue items
Where appropriate effectively negotiates using negotiation tactics for settlements
Executes on 90-day interface claim reviews with quality and timeliness as prescribed by client’s service plan.
Communicate effectively with all internal and external business partners using all forms of communication to obtain timely contact.
Written and verbal communication is professional and timely.
Communicate effectively by expressing oneself in a clear and concise manner in one-one and group discussions while listening attentively in collaborative discussions.
Foster a sense of energy, urgency, ownership, and personal commitment to work.
Participation and coordination in client claim reviews and/or teleconferences.
Occasional travel to clients for claim reviews where warranted.
Promotes culture of collaboration and teamwork across all organizational boundaries.
Recognizes clients that participate in occupational health structures with compliance to their respective special protocols.
Analyzes the nature of the loss, compensability, and scope of the injury for adequate reserving and actions needed to move claim forward.
Utilizes Nurse Case Management as needed for complex claims
Works with defense council regarding questionable compensability scenarios and IME doctor selection.
Maintain Medicare screens to meet Section 111 requirements.
Ensure qualifying cases have Medicare Set Aside.
Well versed in multiple jurisdictions.

Benefits

IPMG offers a Year End Bonus to qualified employees
20 days of PTO each year.
2025 includes 13 paid holidays and YOUR BIRTHDAY OFF!
Medical, dental, and vision coverage on day one of full-time employment.
Telemedicine is free for you and your family (day one) if you are covered under our medical plan.
401k match.
Professional development support and a Linkedin Learning subscription.
Flexible time off with an encouraged time away to support a healthy work-life balance.
Life Insurance, Short term, and long-term disability on day one of full-time employment and paid for by IPMG.
Onsite fitness center and showers, in our St. Charles, IL HQ office.