Workers' Compensation Claim Adjuster (DE, DC, MD)

Ccmsi•Wall Township, NJ

12h•Hybrid

About The Position

The Workers' Compensation Claim Consultant (Adjuster) is responsible for the investigation and adjustment of assigned claims. This adjuster will focus on DE, DC, and MD claims. This position may be used as an advanced training position for consideration of promotion to a more senior level claim position. Accountable for the quality of claim services as perceived by CCMSI clients and within our corporate claim standards.

Requirements

Five or more years claims experience is required.
Proficient using MicroSoft Office products such as Word, Excel, Outlook, etc.
Adjuster's license may be required based upon jurisdiction

Nice To Haves

Bachelor degree is preferred.

Responsibilities

Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
Establish reserves and/or provide reserve recommendations within established reserve authority levels.
Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims.
Negotiate any disputed bills or invoices for resolution.
Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
Assess and monitor subrogation claims for resolution.
Review and maintain personal diary on claim system.
Client satisfaction.
Prepare reports detailing claim status, payments and reserves, as requested.
Compute disability rates in accordance with state laws.
Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.
Prepare newsletter articles, as requested.
Provide notices of qualifying claims to excess/reinsurance carriers.
Handle more complex and involved claims than lower level claim positions with minimum supervision.
Conduct claim reviews and/or training sessions for designated clients, as requested.
Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
Performs other duties as assigned.