Analyze mid
and higher-level workers compensation claims to determine benefits due
Ensure ongoing adjudication of claims within company standards and industry best practices
Identify subrogation of claims and negotiate settlements
Manage workers compensation claims determining compensability and benefits due on long term indemnity claims
Monitor reserve accuracy and file necessary documentation with state agency
Develop and manage workers compensation claims' action plans to resolution
Approve and process assigned claims and determine benefits due
Manage subrogation of claims and negotiate settlements
Communicate claim action with claimant and client
Ensure claim files are properly documented and claims coding is correct
Maintain professional client relationships

Bachelor's degree from an accredited college or university preferred
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

Claims Adjuster – WC

Key skills