Claims Adjuster - Workers Compensation

About the role

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

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
• Performs other duties as assigned
• Supports the organization's quality program(s)

Qualifications

• Bachelor's degree from an accredited college or university preferred
• Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skill
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations

Benefits

• Healthcare Insurance: Eligible employees and their dependents receive coverage through BlueCross BlueShield of Illinois. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment. Premiums are subsidized by Synectics
• Dental Insurance: Eligible employees and their dependents receive dental plan through MetLife. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment
• Vision Insurance: Eligible employees receive vision insurance through VSP. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment
• 401(k) Plan: The Synectics Inc. Investment Savings Retirement Plan. All employees who are 21 years of age or older may invest in the 401(k) Plan on the first of the month following at least 1 calendar year after employment begins