WC Claim Adjuster

SUMMARY

Workers Comp  Adjuster investigates and analyzes claims. Determines coverage and negotiates settlement with claimants.  Minimum experience level should be between 3-5 years.

JOB REQUIREMENTS:

• 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 vendor for medical bill review
• Presents thorough and accurate reports to clients and excess carriers on claims investigations/situations
• Negotiates settlements for resolutions with claimants and their attorneys
• 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 operate a personal computer using standard or customized software applications appropriate to assigned tasks
• Ability to prepare and present accurate and reliable reports containing finding and 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
• 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 minimum of 3-5 years of experience in handling workers’ compensation claims. A college degree or equivalent business experience needed.  Texas Non-Subscribers claims handling is a plus.