Workers Compensation Claims Adjuster II

Role Overview

• Reports directly to the unit Claims Supervisor.
• Responsible for effectively managing to conclusion an assigned inventory of claim files.
• Perform a three-point contact on all new losses within 24 hours of receipt of the claim.
• Document relevant facts surrounding the incident as well as disability and treatment status.
• Gather evidence regarding ongoing case facts necessary for establishing compensability.
• Assure all assigned indemnity claims have an up to date plan of action.
• Form a partnership with the medical case manager to maximize return to work potential.
• Initiate referral to the SIU of cases with suspected fraud.
• Aggressively pursue subrogation from culpable third parties.
• Ensure the claim file is handled in accordance with applicable statutes and service contracts.
• Review and approve all vocational rehabilitation plans, plus health insurance and medical bills.

Requirements

• Bachelor’s degree (B. A.) or equivalent from four-year college or
• 3-5 years related experience & training, 5 years without a SIP certificate, or equivalent combination of education and experience.