What are the responsibilities and job description for the Claims Adjuster - Workers Compensation position at CYNET SYSTEMS?
Job Description:
Responsibilities:
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.
- Bachelor's degree from an accredited college or university preferred.
- Four years of claims management experience or equivalent combination of education and experience required.
- Working knowledge of regulations, offsets and deductions, disability duration, medical management practices.
- 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.
Salary : $56,600 - $73,400
