Claims Adjuster - Eteam : Job Details

Job Title: Claims Adjuster - Workers Compensation (Hourly) Location: 100% Remote Duration: 3 Months plus (Possibility of Extension) Description: Manager's note:-

• Mandatory: Workers Comp experience in Southeast state jurisdictions some or all AL. GA, FL, NC, SC, TN
• Experience: 5+ years of relevant WC experience with above mentioned states.

PRIMARY PURPOSE:

• To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

QUALIFICATIONS: Education & Licensing

• Bachelor's degree from an accredited college or university preferred.

Experience:

• Four (5) years of claims management experience or equivalent combination of education and experience required.