Claims Adjuster

This role is remote, within the United States. Candidates must live in and have authorization to work in the United States.

Visa sponsorship not available

We are searching for a Claims Adjuster to join our team!

This position requires workers compensation multi-state licenses to review and handle national (multiple states) workers compensation claims.

Investigate, analyze, and determine the extent of company's liability concerning workers compensation claims and attempt to achieve appropriate claim resolution as allowed within each States jurisdiction.

Correspond with or interview medical specialists, agents, witnesses, insured’s and / or claimants to compile information and determine claim compensability.

Calculate benefit payments and approve payment of claims within your assigned claim authority. All tasks are to be performed with the goal of demonstrating superior claims handling expertise.

Requirements

• Review and handle workers compensation claims in multiple jurisdictions.
• Under technical direction, works within limits and authority on assignments of higher technical complexity and coordination.
• Responsible for claims management of assigned cases within guidelines of Company performance standards.
• Opens new claims, completes three-point contact, and performs needed investigations to determine compensability as well as possible subrogation or apportionment, according to state and / or company’s timeframes and guidelines.
• Maintain appropriate case reserves utilizing the corporate philosophy of establishing the ultimate probable exposure on each claim generally within the first 6 months of the life of a claim but no later than 12 months from received date of loss.
• Ensure all reinsurance reports are prepared thoroughly, accurately with clear language making it easy for reinsurers to understand and all reports are submitted within 30 days of their due date.
• Follows appropriate procedures for system documentation to preserve data integrity.
• Creates and executes action plans needed to bring claims to closure.
• Completes detailed claim resolution plans and recommends appropriate plan of action, within authority.
• Maintains regular contact with injured workers, insured employers and agents to develop positive relationships and establish credibility.
• Provides meaningful participation in Large Loss review meetings to improve other departments understanding of claims processes generally and for the specific claim under review.
• Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
• Works productively and harmoniously with others on a consistent basis.
• Responds positively to direction and criticism of performance.
• Consistently maintain professional and appropriate demeanor.
• Conducts training and mentors new hires.
• Perform other duties as assigned.
• Possesses a higher and more extensive level of industry claim knowledge and skills on a National level.
• Administers and monitors rules, guidelines, insurance laws, and regulations.
• Maintain a high degree of trust through demonstrated personal integrity and ethical behavior.
• Works in collaboration with Vice President of Claims, Director of Claims, Claims Manager and Claims Supervisor.
• Responsible to maintain current on industry technical knowledge and skills.
• Minimum of 3 to 5 years workers’ compensation claims handling experience required in multiple states.
• Must hold valid workers’ compensation licenses in multiple jurisdictions.
• National exposure in claims handling / compliance is a plus.
• Strong verbal and written communication skills with emphasis on telephone communication required.
• Strong math and reading skills required.Bachelor’s degree or equivalent combination of training / experience required.
• Meets all state regulatory standards regarding licensing, continuing education, and other requirements.

Benefits

Service Insurance Companies offers a competitive benefits package, including :

• Healthcare (medical, dental & vision)
• Voluntary benefits (life & disability insurance)
• 401K & profit sharing
• Generous paid time off & holidays
• Tuition reimbursement training
3 days ago