Senior Claims Adjuster (Workers Compensation)

Position Purpose

Independently investigates, evaluates, and negotiates the resolution of assigned claims within approved authority. Responsible for making recommendations for claim outcomes on claims exceeding level of authority.

Logistics

Planned Administrators Inc. (PAI) - one of BlueCross BlueShield's South Carolina subsidiary companies.
Full-time position, Remote schedule, 8-hr. shift (40-hours/week) Monday-Friday 8:00am – 5:00pm with primary location at 17 Technology Circle Columbia SC, Columbia, SC 29203.
Qualified, local candidates only due to initial training period and some on-site activities.

What You'll Do

• Conduct investigations of assigned claims (workers comp, first and third party property, general liability or auto physical damage) in adherence with corporate timeliness and quality performance standards.
• Manage (catastrophic, high exposure and complexity) caseload to ensure proactive disability, medical management and timely response to treatment recommendations, ongoing contact with the injured and insured, and a 100% closing ratio.
• Document activities, case action plans, settlements evaluations and requests for authorizations in the claim notes.
• Provide management and internal and external customers with documentation to support recommendations and claim status as required.
• Direct litigation process and work with attorneys to establish defense strategy and case legal budget. Negotiate settlements directly with claimants or opposing counsel. May require attendance or testimony at hearings, trials, or mediations.
• Evaluate specials, damages, and/or extent of disability and negotiate settlements with individuals and/or attorneys.
• Utilize independent adjustors to assist in the evaluation of liability and for damages and reports findings. Reviews independent adjustor's reports and handles claim outcome.

To Qualify For This Position

• Required Education: Bachelor's degree (see degree equivalency below)
• Required Work Experience: 4 years of area related adjusting experience

Required Skills and Abilities

• Ability to analyze laws, regulations and contract language.
• Ability to evaluate issues and develop recommendations.
• Ability to handle confidential and sensitive information.
• Ability to investigate assigned claims and propose claims adjustments and refunds.
• Strong verbal and written communication skills.
• Strong interpersonal skills.

Required Software and Other Tools

• Microsoft Office.

We Prefer That You Have The Following

• Strong organizational skills.
• Solid ability and experience navigating multiple systems.
• Able to work independently.
• Able to manage distractions effectively.
• Strong communication skills, both verbally and written.

Our Comprehensive Benefits Package Includes The Following

• Subsidized health plans, dental and vision coverage.
• 401k retirement savings plan with company match.
• Life Insurance.
• Paid Time Off (PTO).
• On-site cafeterias and fitness centers in major locations.
• Education Assistance.
• National discounts to movies, theaters, zoos, theme parks and more.

What We Can Do For You

• We offer our employees great benefits and rewards.
• We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next

• After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

• BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status.
• Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans.
• We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.