Workers' Compensation Claims Adjuster

Responsibilities

Summary

Investigate all assigned claims to determine if any benefits are due under state workers’ compensation statutes. Process all benefits due to injured workers and act as a key contact for insureds.

• Initiate contact with all parties involved in the claim on a timely basis to provide effective customer service
• Investigate all claims to determine if the injury/disease occurred in employment, requiring payment of medical or wage loss benefits
• Refer all medical bills to vendors for review and audit, ensuring that all bills are paid within allotted time frames
• Maintain files and diaries to ensure easy review by supervisors and auditors
• Assign, monitor, and direct defense counsel in settlement negotiations and claim handling
• Review and remain updated on current laws with state workers’ compensation boards

Qualifications

• Bachelor’s Degree from a four year university or college, or equivalent work experience
• 2-4 years work experience in either the insurance or medical industries
• Workers’ compensation claims adjusting experience strongly preferred
• Strong capability to communicate with insureds, claimants, nurses, and attorneys
• Ability to read and interpret documents such as medical records, insurance policies, and state workers’ compensation laws
• The desire and ability to work in a fast-paced environment
• Knowledge of Microsoft Office, particularly Word, Excel, and Outlook functions
• Proficient in interpreting insurance policies, performing basic medical condition research
• Strong analytical skills to make decisions to determine coverage and compensability of claims
• Attention to detail and accuracy

For candidates with three or more years of workers' compensation claims experience the position may be a Job Level 6

Reports To: Claims Supervisor

Job Level: 5

Number of Openings: 2