What are the responsibilities and job description for the Sr. Claims Adjuster (Workers Compensation) position at Elite Services?
Must have TEXAS workers' compensation license and seeking 5 years experience in lost time work comp claims for TEXAS jurisdiction.
POSITION SUMMARY : Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.
DUTIES AND RESPONSIBILITIES :
- Effectively manages a caseload of 110 to 160 workers' compensation files, including very complex claims.
- Initiates and conducts investigation in a timely manner.
- Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
- Manages medical treatment and medical billing, authorizing as appropriate.
- Communicates with claimants, providers and vendors regarding claims issues.
- Computes and set reserves within Company guidelines.
- Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
- Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
- Adheres to all Company policies and procedures.
- Conducts file reviews independently.
- Other duties as assigned.
- Essential job function.
EQUIPMENT OPERATED / USED : Computer, 10-key, fax machine, copier, printer, and other office equipment.
QUALIFICATIONS REQUIRED :
Education / Experience : High School Diploma or GED required. Bachelor's degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.
Knowledge, Skills and Abilities :
Other Qualifications :
