Senior Claim Adjuster

SUMMARY

Investigates and evaluates losses while developing a plan of action to bring claims to proper resolution in a timely manner.    Experience level preferably between 5-7 years. 

JOB REQUIREMENTS:

• Determines extent of insurance coverage and compensability on each filed claim
• Investigates claims, including interviewing employees, employers and witnesses
• Obtains necessary records, including but not limited to, hospital records, police reports, physician records, etc.
• EDI and CMS/Section 111 reporting
• 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
• May be asked to mentor, train and/or share expertise with other ASC staff
• May be asked to serve as back up to supervisor or manager when they are unavailable.
• 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
• Is responsible for catastrophic losses, complex litigation, and other sensitive issues
• 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
• 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
• Ability to comprehend multi-state laws and regulations to assist other offices, as necessary 
•  
• Required Experience:

Should have 5-7 years experience in handling workers’ compensation claims.  A

college degree or equivalent business experience needed.