Workers Compensation Adjuster-Full-Time-Days

Cape Fear Valley Health

7d•Onsite

About The Position

This position involves collaborating with the Workers' Compensation Manager to process workers' compensation claims for the health system. The role demands a high level of communication and analytical skills, especially when handling sensitive and confidential information related to workers' compensation claims. Key responsibilities include investigating employee injury events, conducting interviews, filing required documentation with State agencies, managing assigned workers' compensation claims, maintaining daily diary events, and tracking data in a database. The adjuster is responsible for approving all levels of workers' compensation claims and reviewing/verifying payments for services and disability amounts in conjunction with the workers' compensation program and individual claims.

Requirements

Associate’s degree in business or a related field is required
Current North Carolina Claims Adjuster's License and in good standing required
Valid North Carolina driver’s license required
4 years’ experience in workers' compensation claims administration required
Proficiency in reading, writing, and speaking the English language
Knowledge of North Carolina workers' compensation law
Understanding of litigation processes and importance of documentation
Knowledge of OSHA regulations
Ability to work with people in a professional, tactful, and diplomatic way
Ability to work independently and accomplish tasks in timely manner
Ability to organize and prioritize activities and tailor procedures to a smoothly functioning department
Ability to work with variety of changing activities from entering data into computer database to making highly technical decisions
Ability to hold in confidence highly sensitive information and materials
Proficiency with Microsoft Office software (e.g., Outlook, Word, Excel, etc.)
Proficiency with the use of a claims database, e.g., iVOS or another insurance carrier’s database

Nice To Haves

Bachelor’s degree preferred
3 years’ of experience in safety, legal, and insurance environment preferred

Responsibilities

Investigate and analyze data to determine compensability in accordance with the NC Workers’ Compensation Act
Manages assigned workers' compensation claims in a timely manner
Attend workers' compensation mediations and NC Industrial Commission hearings as required
Independently works within certain limits and authority to actively manage a caseload of complex lost time cases
Establish claim reserves, propose and negotiate settlements under the supervision of the Workers’ Compensation Program Manager
Approve disability and medical payments and other expenses related to workers' compensation claims
Review employee incident report to determine which employee injury/illness incidents meet OSHA recordability criteria and documents individual files in database accordingly
Prepares NC Industrial Commission forms and dispatches them to responsible parties
Collect, enter, and update information in workers' compensation software database
Maintain claims diary and completes diary items in timely manner
Review and verify bills for services provided in conjunction with workers' compensation program and individual claims
Authorize check requests for workers' compensation benefits, medical payments, case management bills, settlement checks in addition to other miscellaneous expenses
Assist with preparation for workers' compensation legal proceedings
Keeps current with laws and regulatory requirements related to workers' compensation and OSHA to assist the Health System in maintaining compliance with same
Maintain strict confidentiality of all documentation, information, and work-product
Other duties as assigned