Worker's Compensation Claims Adjuster

Responsibilities

• Review and handle claims in multiple jurisdictions.
• Under technical direction, works within limits and authority on assignments of higher technical complexity and coordination.
• Responsible for claims management of assigned cases within guidelines of Company performance standards.
• Opens new claims, completes three-point contact, and performs needed investigations to determine compensability as well as possible subrogation or apportionment, according to state and/or company’s timeframes and guidelines.
• Maintain appropriate case reserves utilizing the corporate philosophy of establishing the ultimate probable exposure on each claim generally within the first 6 months of the life of a claim but no later than 12 months from received date of loss.
• Ensure all reinsurance reports are prepared thoroughly, accurately with clear language making it easy for reinsurers to understand and all reports are submitted within 30 days of their due date.
• Follows appropriate procedures for system documentation to preserve data integrity.
• Create and execute action plans needed to bring claims to closure.
• Completes detailed claim resolution plans and recommends appropriate plan of action, within authority.
• Maintain regular contact with injured workers, insured employers and agents to develop positive relationships and establish credibility.
• Provides meaningful participation in Large Loss review meetings to improve other departments understanding of claims processes generally and for the specific claim under review.

Qualifications

• Minimum of 3 to 5 years workers’ compensation claims handling experience required in multiple states.
• Must hold a valid multi-state license that includes California.
• National exposure in claims handling/compliance is a plus.
• Strong verbal and written communication skills with emphasis on telephone communication required.
• Strong math and reading skills required.
• Bachelor’s degree or equivalent combination of training/experience required.
• Mets all state regulatory standards regarding licensing, continuing education, and other requirements.