Senior Claims Adjuster

General Search & Recruitement Published: October 11, 2017
Category

Description

Senior Claims Adjuster

Saint Charles, IL

As Senior Claims Adjuster, you will be responsible for performing technical work on
intermediate to complex workers’ compensation lost time and litigated claims;
establishing reserves for medical treatment, expenses, and indemnity; and
following claims through resolution.


This role operates in a self-directed
workflow as well as under direct administration from the WC Claims Manager.


Responsibilities:

You will coordinate the review,
evaluation, and processing of workers’ compensation lost time and litigated
claims

Analyze first reports to determine
the nature of the loss, compensability, and scope of the injury

Recognize clients that participate
in client’s plan and request/obtain the medical authorizations forms

Recognize clients that issue the
PEDA benefits and request payments issued to the employee, ensure timely TTD
payments are issued, and reimbursements are paid to the client

Initiate contact with employers,
injured employees, doctors, and other parties to conduct a full investigation

Obtain and review medical records
and claim-related correspondence and determine appropriate action for each case

Establish accurate and timely
reserves, both initial and ongoing, to close claims

Authorize or deny all payments on
the claim file

Provide information to clients,
claimants, doctors, and others regarding the status of claims

Recognize workers’ compensation
subrogation opportunities and determine if subrogation should be pursued; when
appropriate, collect and review all necessary documentation, contact all
appropriate parties, and pursue any third-party recoveries

Effectively utilize defense
partners and negotiate settlements where appropriate 

Work within the assigned authority
level

Effectively communicate with all
internal and external business partners

Maintain files notes in accordance
with established procedures, timely diary management, and claim closing goals

Qualifications:

5+ years of workers’ compensation adjusting experience

Current adjuster license

High school diploma or GED, and Bachelor’s degree or
equivalent experience

Intermediate to advanced level of demonstrated knowledge and
skill in claim handling: investigation, written and verbal communication,
litigation management, subrogation, medical management, negotiation, reserving,
jurisdictional regulations

Experience handling intermediate to complex workers’
compensation claims

Proven time management skills

Excellent verbal and written communication skills

A detail-oriented and self-directed approach

Previous experience at a Third-Party Administrator

Previous experience handling multi-jurisdictional claims

Expertise in Microsoft Office Suite, especially Outlook,
Word, and Excel

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