Successfully completes classroom training introducing workers compensation claims handling strategies, medical terminology, statutory requirements, and investigative skills.
Conducts initial investigation of reported claims to determine coverage, compensability, severity, and gather all other relevant information via three-point contact telephone calls.
Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
Develops and updates a Plan of Action for the successful resolution of each claim.
Makes prompt, sound decisions on issues that arise based on the best information available, ensuring that work is performed in accordance with Company guidelines and applicable statutory requirements. Timely escalates issues/red flags to Supervisor.
Ensures benefits due injured worker are calculated and issued appropriately in accordance with legal requirements including the issuance of appropriate notices and filings.
Fosters a positive and close working relationship with internal and external partners, including Call Center, Medical Management, Special Investigations, and Indemnity Adjusting Staff.

Minimum of High School Diploma or equivalent certificate required; Bachelor’s degree from four-year college or university is preferred.
Minimum one year of related training or general experience
Ability to communicate effectively verbally and in writing; bilingual ability preferred
Exceptional interpersonal and customer service skills
Ability to manage and prioritize multiple assignments in a fast-paced environment
Strong organization skills to ensure tasks are completed within hard deadlines
Basic mathematical skills to calculate monetary reserves
Knowledge of Microsoft Word, Powerpoint, Excel, Outlook

Claims Adjuster – Trainee

About this role