NARS Insurance Jobs


Claims Adjuster - Sr. Work's Compensation

Greenville, South Carolina (US)

 

Handle a caseload of approximately 170 pending Medical Only claims. Requires establishing facts of loss, coverage analysis, investigation, compensability/liability/negligence determination, coordination of medical care, identifying potential fraud & appropriate use of authorized vendors. Includes timely & appropriate reserve analysis and payment of medical bills. File handling must be within state statutes, Client Claims Handling Guidelines & NARS Best Practices.

Essential Duties & Responsibilities:

  • Identify, analyze and confirm coverage.
  • Manage Medical Only WC claims to conclusion within state statutes and guidelines.

Customer Service/Contact:

  • Contact appropriate parties & providers to determine compensability & subrogation potential.
  • Contact appropriate parties to obtain any needed information & explain benefits as appropriate.
  • Continue contact during life of file as appropriate.
  • Answer phones, check voice mail regularly & return calls as needed.
  • Assist management when required with projects or leadership as requested.

Subro:

  • Refer all files identified with subrogation potential to the subrogation department.

Investigation:

  • Verify facts of loss & pertinent claims facts such as employment, wages, or damages & establish disability with treating physicians as appropriate.

Qualifications:

Technical skills:

  • Advance level of interpersonal skills to handle sensitive/confidential situations & information.
  • Requires advanced ability to work independently, an advanced level of organization, time management skills & advanced level written & verbal communication skills.

Abilities:

  • Requires long periods of sitting, working indoors in environmentally controlled conditions,
  • Lifting of files/boxes up to 20#, use of keyboard/mouse & exposure to computer screens,
  • Travel as assigned.