Senior Claims Adjuster

Job Title

Chesterfield County Risk Management

Salary

$71,395.00 - $121,371.00 Annually

Location

Chesterfield, VA

Job Type

Full-Time

Minimum Qualifications

High school diploma or GED; seven years of workers compensation claims handling experience; bachelor's degree preferred; or an equivalent combination of training and experience.

Required Knowledge, Skills and Abilities :

In depth knowledge of the workings of the Virginia Workers Compensation Commission; knowledge of the Virginia Workers Compensation Act and how to apply the laws and regulations of the Act in decision making and adjusting claims; analytical and interpretive skills when applying law; strong interpersonal skills, negotiation skills, strong organizational skills, excellent multi-tasking skills, and be able to meet deadlines; understanding and applying County administrative policies, HIPPA, FMLA, Medicare, VRS, and the department of Risk Management procedures for adjusting claims; Computer skills; knowledge of RMIS system; Microsoft office products; being able to read and understand complex case law that applies to claims; being able to make decisions on treatment based on medical records.

Current, valid driver's license and good driving record required. Based on the Virginia DMV point system, record must not reflect a total of six or more demerit points within the twenty-four months preceding the anticipated hire date, or one major violation of six demerit points within the preceding thirty-six months. Out of state driving records must be obtained by applicant and presented at time of interview. Records must reflect at least three years of history and be dated within thirty days of interview date.

Pre-employment drug testing, FBI criminal background check, and education / degree verification required.

Duties

Under general supervision, performs work of considerable difficulty in analyzing and managing complex and technically difficult claims by investigating and gathering information and applying all laws and regulations of the Virginia Workers Compensation Commission (VWCC).

Duties include but are not limited to the following :

• Adjust Workers Compensation Claims by reviewing claims, gather, and analyze information from claimant, supervisor, witnesses, and medical providers to provide a compensability decision based on Virginia Workers Compensation laws and regulations;
• Authorize bi-weekly payments to claimants, no longer employed individuals, within the time required to avoid payment penalties;
• Report all monetary transactions, including lost time benefits as well as medical benefits through Virginia Workers Compensation Commission Electronic reporting system, as well as reporting through legal agreements signed by both parties;
• Document all activity in the Claims system;
• Report timely to Excess Carrier Insurance Companies within their policy requirements to assure reimbursement of funds when SIR is reached;
• Assess claim to determine the feasibility of settlement for the benefit of the County, School System as well as the employee;
• Train Claims Technicians on the claim procedures;
• Record OSHA accident information;
• Attend meetings with departments, county attorneys, school human resources representatives for claim updates;
• Prepare for appealed claims for hearings conducted at VWCC;
• Perform other work as required.

This position is part of an approved Career Development Plan (CDP) and offers career progression opportunities and salary incentives, as funding permits, based on performance, qualifications, and experience.

Shift

Monday - Friday; 8 : 30 a.m. - 5 : 00 p.m.

Work Location

Risk Management

Chesterfield County is an Equal Opportunity Employer Committed to Workforce Diversity, Equity, and Inclusion