Workers Compensation Claims Adjuster I
About The Position
Summary: Under close supervision, analyzes insurance claims to determine extent of insurance carrier's liability and settles claims with claimants in accordance with policy provisions by performing the following duties. Essential Duties and Responsibilities: Three-point contact, initial investigation, initial benefit determination. Ability to identify and address questionable (AOE/COE) claims. Establish and monitor reserves at periodic intervals. Prepare claims status report to carriers at 90-day intervals. Ability to manage and direct medical care, including strategies to maintain medical control and objection when appropriate. Identify and rate permanent disability. Vocational Rehabilitation file management Negotiate and finalize claim settlements as well as lien settlements. Identify and manage subrogation issues on workers’ compensation claims. Work independently and in a fast paced environment.
Requirements
- Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
- Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
- Interpersonal - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
- Team Work - Supports everyone's efforts to succeed.
- At least 1-3 years experience as a Workers’ Compensation Claims Assistant, or up to one year Trainee or Future Med Adjuster experience; or Bachelor’s degree (B.A.) and six months experience.
Responsibilities
- Three-point contact, initial investigation, initial benefit determination.
- Ability to identify and address questionable (AOE/COE) claims.
- Establish and monitor reserves at periodic intervals.
- Prepare claims status report to carriers at 90-day intervals.
- Ability to manage and direct medical care, including strategies to maintain medical control and objection when appropriate.
- Identify and rate permanent disability.
- Vocational Rehabilitation file management
- Negotiate and finalize claim settlements as well as lien settlements.
- Identify and manage subrogation issues on workers’ compensation claims.
- Work independently and in a fast paced environment.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Number of Employees
251-500 employees
