Claims - Senior Claim Adjuster – Workers’ Compensation

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:

· Confirms coverage and addresses compensability and causation on each claim

· Investigates claims, including interviewing employees, employers and witnesses

· Obtains necessary records, including but not limited to, hospital/physician records, police

reports, etc.

· EDI state filings and CMS/Section 111 reporting

· Utilizes appropriate preferred vendors

· Presents thorough and accurate reports to clients and excess carriers on claims

investigations/status updates

· Negotiates settlements for resolution with claimants or 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

· Participates in client meetings, both telephonic and face to face

· 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 either workers’ compensation or liability claims. A

college degree or equivalent business experience needed.