Multi-line Claim Adjuster

JOB REQUIREMENTS:

• EDI and CMS/Section 111 reporting
• Determines extent of insurance coverage and compensability on each filed claim
• Investigates claims, including interviewing employees, employers, witnesses
• Obtains necessary records, including but not limited to, hospital records, police reports, physician records, etc.
• Utilizes appropriate preferred vendors
• Presents thorough and accurate reports to clients and excess carriers on claims investigations/situations
• Negotiates settlements for resolutions with claimants and their attorneys
• Maintains control of litigation activities and costs per account requirements
• Attends meetings; conferences; workshops or training sessions; and reviews written material to maintain current knowledge on principles, practices and new developments in assigned work areas
• Maintains and meets state specific licensing requirements
• Responds to client questions and comments in a courteous and timely manner
• All other duties as assigned

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

• Ability to understand and follow oral and/or written policies, procedures and instructions
• Ability to perform a wide variety of duties and responsibilities with accuracy and speed, while meeting time-sensitive deadlines
• Ability to conduct investigations in multi-party situations
• Ability to use standard or customized software applications appropriate to assigned tasks
• Ability to prepare and present accurate, reliable and factual reports with  recommendations
• Thorough knowledge of current principles and practices associated with claims investigations, adjustment and related practices including appropriate State and Federal statutes

• Extensive knowledge of medical and legal terminology with a thorough understanding of legal principles/litigation management
• Ability to handle confidential information
• Ability to communicate effectively with others both orally and in writing
• Ability and willingness to learn quickly and utilize new skills as a result of rapidly changing information and/or technology

Required Experience:

Should have 3 - 5 years experience in handling workers’ compensation and liability claims.  A college degree or equivalent business experience needed.