Senior Workers’ Comp Claims Adjuster

InterMed Cost Containment Services; Fully; On-site; CHF 70,000 - 78,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

HSA contributions

401(k) match

PTO & holidays

Job summary

AvonRisk is seeking a Workers' Compensation Claims Adjuster to manage all aspects of state Act workers' compensation claims, including determining compensability, administering benefits, negotiating resolutions, and supporting claimants, employers, and medical/legal professionals throughout the claim lifecycle.

You will interview claimants, maintain records, set reserves, coordinate medical exams, and collaborate with legal counsel and underwriters to ensure proper handling and timely reporting

Qualifications

• 5+ years experience handling CT, DE, MD, CA, NJ, PA, RI Workers Compensation claims and multi-state Adjuster license.
• Experience in, and hold a current adjusters license to handle WC claims in CT, DE, MD, CA, NJ, PA, RI - preferred
• High School education

Responsibilities

• Receives newly reported claims.
• Determines coverage under the State WC Act, and any exposure to LHWCA.
• Maintains and updates claim notes throughout lifespan of claim.
• Records claim information in electronic database.
• Interviews claimants, insureds, medical professionals and witnesses to determine claim validity.
• Communicates claim compensability decisions to claimant, employer and medical provider.
• Sets appropriate reserves based on nature/extent of injury.
• Calculates lost time wages, makes disability payments directly to claimants. Diaries future payments as appropriate.
• Reports all mandatory claims data directly to State entities within required timeframes.
• Orders independent medical examination as necessary and prepares all relevant documentation for physician review.
• Maintains regular correspondence with claimants, insureds, clients, and nurse case manager to include claim updates, medical appointments, or issues with disability payments.
• Reviews and processes medical bills for additional discount opportunities.
• Aggressively collaborates with claimants, clients and insureds to ensure early return-to-work is pursued.
• Works in partnership with legal counsel to warrant that insured’s interests are protected on litigated claims.
• Attend settlement conferences, mediations, and hearings on behalf of the insurance company
• Reviews and approves defense attorney bills within authority
• Works with underwriting to help provide relevant information on losses for renewal rates as well as Risk Management to identify trends.
• Responds to State requests for health cost disputes, applications for hearings and penalty assessment letters
• Identifies subrogation potential and pursues recovery
• Leads claim reviews with clients as requested

Skills

Microsoft Office

Workers' comp laws

Medical terminology

Communication skills

Attention to detail

Negotiation

Customer service

Relationship building

Adaptability

Education

High School diploma

Multi-state adjuster license

5+ years WC claims experience

Job description

AvonRisk is seeking a Workers' Compensation Claims Adjuster to manage all aspects of state Act workers' compensation claims, including determining compensability, administering benefits, negotiating resolutions, and supporting claimants, employers, and medical/legal professionals throughout the claim lifecycle.

You will interview claimants, maintain records, set reserves, coordinate medical exams, and collaborate with legal counsel and underwriters to ensure proper handling and timely reporting