To analyze mid
and higher-level workers compensation claims to determine benefits due
To ensure ongoing adjudication of claims within company standards and industry best practices
To identify subrogation of claims and negotiate settlements
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
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

Bachelor's degree from an accredited college or university preferred
Licensed and Experienced in the following jurisdictions highly preferred: TX. and LA
Four (4) 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 and 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

Workers' Compensation Claims Adjuster

Key skills