About this role
Role Overview
- Investigate workers compensation claims as assigned by claims supervisor
- Determine compensability of claim and liability based upon facts, applicable negligence laws, case law and statutes
- Responsible for managing workers’ compensation claims as assigned by claims supervisor
- Communicates directly with clients, employers, injured workers, physicians, and attorneys to bring claims to a timely conclusion
- Interviews, telephones, or corresponds with claimant and witnesses, consults police and hospital records
- Documents all information from contacts with employers, claimants, physicians, and attorneys into the claims’ management system and ensures that documentation is current
- Reviews claims’ submissions for thoroughness and accuracy
- Determines compensability of claims through information gathered and according to workers’ compensation statutes
- Makes recommendations as to compensability and coverage of claims
- Provides guidance and advice to clients on direction of claims after all information has been gathered and analyzed
- Ensures jurisdictional filings are complete and timely
- Obtains pre-certification approval for specific treatments as needed
- Reviews bills and medical notes; authorizes and codes bills
- Attends seminars and meetings as needed to stay abreast of current industry knowledge
- May attend mediations, hearings, trials or other legal proceedings
- Processes medical-only workers’ compensation claims involving minor injuries and/or payment
Requirements
- High School degree or equivalent is required
- At least two years college credit from a four-year college or university; or an Associate's degree from a two-year college; or an Associate in Claims designation from the Insurance Institute of America is preferred
- Minimum of two years of workers’ compensation claims handling experience
- Client services skills and/or training
- NC/SC WC adjuster experience
- Claims Adjuster license(s) as mandated by applicable state(s) are required
- Current valid drivers’ license is required
- Ability to read, analyze and interpret common technical journals, financial reports and legal document
- Ability to respond to common inquiries or complaints from customers, state agencies or members of the business community
- Ability to effectively present information to management, employers, boards of directors and other committees
- Ability to effectively interview claimants and other interested parties
- Ability to work with mathematical concepts and apply concepts such as percentages, fractions, rations and proportions to practical situations
- Ability to define problems, collect data, establish facts and draw valid conclusions
- Ability to interpret a variety of technical instructions and deal with several variables
- Ability to effectively negotiate claim settlements
Benefits
- Comprehensive medical insurance, dental insurance, and vision insurance
- Life and disability insurance
- Fertility benefits
- Wellness resources
- Paid sick time
- Generous paid time off and holidays
- Employee Assistance Program (EAP)
- Complimentary Calm app subscription
- Immediate vesting in a 401(k) plan
- Health Savings Account (HSA) and Flexible Spending Account (FSA) options
- Commuter benefits
- Employee discount programs
- Paid maternity leave and paid paternity leave (including for adoptive parents)
- Legal plan options
- Pet insurance coverage