Claims Adjuster

Description:

Manage within company standards and best practices complex and problematic high visibility workers' compensation claims within delegated limited authority to determine benefits due, work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer requirements to achieve the best possible outcome in the claim.

Essential Job Duties

Receives claim, confirms policy coverage & acknowledgement of claim

Determine validity & compensability of claim by investigating & gathering info, file necessary documentation with state agencies

Establish reserves & authorize payments within reserving authority limits

Develop and manage well documented action plan with case manager, attorney, supervisor & client to reduce overall cost of claim

Coordinating early return to work efforts with case manager & employer

Negotiates settlements when necessary

Actively manage the litigation process

Identifies potential subrogation claims

Communicate claim status with customer and claimant

Adhere to client guidelines & participate in claim reviews as needed

Develops & maintains professional customer relationships

Education/Training Requirements

Degree at an accredited college or university preferred

Three years handling claims WC Lost Time

Excellent oral, written communication skills & customer service

PC literate, including Microsoft Office (Word, Excel)

Effective analytical & interpretive skills

Strong organizational skills

Great interpersonal skills