TPA Claims Specialist II

Responsibilities

• Adjust lost and non-lost time workers compensation claims.
• Apply advanced knowledge of claims function and processes.
• Communicate effectively with internal and external customers.
• Apply strong understanding of workers compensation claims management, strategies, resolution techniques and adjusting.
• Enter first reports of injury and adjust lost time and non-lost time claims utilizing TPA claim management systems.
• Participate in claim advocacy and negotiations, including claim denials, reserving files, claim reporting, issuing payments, attending hearings, conciliations or mediations, and filing state forms.
• Determine compensability of the claim as it relates to the workers compensation jurisdiction.
• Review and approve loss time, medical services, and expenses to be paid on the claims file.
• Plan and attend claim reviews with clients, carriers, and auditors.
• Identify client issues, build a plan towards resolution, and execute and manage internal and external expectations effectively.
• Analyze claims based on TPA best practices as outlined in the "Policy and Procedures" manual.

Qualifications

• Minimum 5 years of claims adjusting experience.
• College degree preferred; high school diploma or equivalent required.
• Proficient-to-expert in MS Office suite of products.
• Must be licensed in all jurisdictions handled.
• Superior written and oral communication skills.
• Ability to work well in a team environment.
• Strong analytical thinking and problem-solving skills.
• Strong organizational skills required.
• Strong negotiation skills required.

Pay

$57,000 - $77,000