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.