What are the responsibilities and job description for the Sr. Work Comp Claims Adjuster (In Office) position at Elite?
***Requires a HAWAII claims adjuster license***
POSITION SUMMARY: At the Direction of the Claims Supervisor and/or Manager-manages all aspects of complex and litigated indemnity claims from inception to conclusion within established authority and guidelines.
This position requires considerable interaction with clients, claimants, Medical providers, Attorneys, vendors, Nurse and Vocational Case Managers and other COMPANY staff.
DUTIES AND RESPONSIBILITIES:Education/Experience: Minimum five (5) or more years related experience; or equivalent, combination of education and experience.
POSITION SUMMARY: At the Direction of the Claims Supervisor and/or Manager-manages all aspects of complex and litigated indemnity claims from inception to conclusion within established authority and guidelines.
This position requires considerable interaction with clients, claimants, Medical providers, Attorneys, vendors, Nurse and Vocational Case Managers and other COMPANY staff.
DUTIES AND RESPONSIBILITIES:
- Effectively manages a case load of indemnity claim files, including very complex and litigatedclaims.*
- Initiates and conducts investigation in a timely manner*
- Determines compensability of claims and administer benefits based upon state law and COMPANY Best Practices for claim handling*
- Manages medical treatment and medical billing, authorizing as appropriate.*
- Refers cases to outside defense counsel and participates in litigated matters*
- Communicates with claimants, attorneys, providers and vendors regarding claims issues.*
- Work in an organized and proactive manner*
- Compute sand set reserves within Company guidelines*
- Settle sand/or finalize all claims and obtains authority as designated*
- Maintains diary system for case review and documents file to reflect the status and work being performed on the file, including a plan of action*
- Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns*
- Conducts file reviews as scheduled by the client and management*
- Identify and review claims for Apportionment assignment*
- Identify and investigate subrogation potential and pursue recovery.*.
- Identify claim standard criteria for excess reporting and reimbursement*
- Assist with State Audit and reporting responses.*
- Mentors less experienced Adjusters
- Other duties as assigned and including claims management of other jurisdictional workers’ comp claims.
- Adheres to all COMPANY company policies and procedures.*
- * Essential job function.
EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment.
SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attireQUALIFICATIONS REQUIRED:
Education/Experience: Minimum five (5) or more years related experience; or equivalent, combination of education and experience.
Knowledge, Skills and Abilities:
- Technical knowledge of statutory regulations and medical terminology.
- Analytical skills.
- Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
- Ability to interact with persons at all levels in the business environment.
- Ability to independently and effectively manage very complex claims.
- Proficient in Word and Excel (preferred).
- Other Qualifications:
- Licenses as required by Jurisdiction.
- Medical, Dental, Vision, Disability & Life Insurance
- 401(k) plan
- Paid time off
- Paid holidays
