The Claims Adjuster manages lost time claims in addition to other complex claims. They determine needed investigations after categorizing the type of claim and evaluate, settle or deny claims, as warranted. The Claims Adjuster also works with defense attorneys and manages litigated claims.
- Manages all types of complex claims, including but not limited to lost time.
- Assesses claims for possible subrogation opportunities.
- Completes three-point investigations to determine compensability, and takes recorded statements of injured employee and witnesses when appropriate.
- Makes timely payment of benefits and ensure accurate and timely processing of required EDI-R3 filings with the State.
- Confirms that Reinsurers have been notified when claims and or reserves reach certain levels per company standards.
- Maintains contact and relationship with all assigned clients, medical providers and injured employees to monitor progress and prompt return to work.
- Completes regular claim reviews with a clear plan of action addressing reserve adequacy and rationale.
- Attends mediations and obtain settlement authority from clients.
- Manages litigation by providing detailed investigative material to respective defense attorneys.
- Makes recommendations to defense attorney on litigation strategy in order to develop the best strategy and outcome.
- Ensures that petition for benefits are responded in a timely basis.
- Follows adjuster diaries for timely completion of routine claim functions e.g. indemnity payments, all required state filings, claim status report due dates, claim reviews.
- Performs other duties as assigned.
- Strong organizational / time management skills, with attention to detail.
- Strong analytical skills.
- Hard working and extremely reliable.
- Must be computer literate with the ability to learn new software applications.
- Ability to function effectively under tight time constraints, consistently meets strict deadlines, prioritize, and handle multiple tasks in a demanding work environment.
- Ability to work independently with limited daily supervision and to work effectively in a team environment.
- Willingness to adhere to all principles of confidentiality.
- Ability to represent the company in a professional manner to both internal and external customers and clients.
- Ability to maintain a high level of tact and professionalism.
EDUCATION AND QUALIFICATIONS
- High School Diploma, College Degree preferred.
- Minimum of 1 years’ experience as a Workers Compensation Medical Only Specialist with proven competency in handling Workers Compensation claims.CERTIFICATIONS/LICENSES
- Workers’ Compensation Adjuster License or All-lines Adjuster License.