Claims Trainee - Workers' Comp Adjudication

New Mexico Mutual; Albuquerque (NM); In loco; USD 42.000 - 65.000; Tempo pieno

Descrizione del lavoro

New Mexico Mutual is seeking a Claims Adjuster Professional Trainee in Albuquerque, NM. The role is designed as a one-year program to introduce the candidate to the workers' compensation claims function under direct guidance from the claims training manager and other management personnel.

During the training, you will engage in claim investigation, determine compensability, analyze benefits, and gain exposure to litigation, mediation, and claims resolution.

Competenze

• Bachelor’s Degree from an accredited college or university.
• No prior claims handling experience is necessary for this position.
• MS Office (Word, Advanced Excel, PowerPoint, Outlook)

Mansioni

• This claim training will cover claim investigation, compensability, policy coverage, statutory law, case law, benefits analysis and payment, litigation, medical and claims resolution.
• Responsibilities include effective and consistent partnership with the employer, injured worker and medical provider, administration of benefits, litigation management and claims resolution.
• Verify claim information including but not limited to: documentation of the claim history; taking recorded statements from workers and witnesses, coordination of medical care.
• Document all activities in the claim management system. Responsible for outside legal counsel assignments, RTW strategies & all other expert assignments.
• Upon determination of compensability: Set and monitor reserves according to company policies and the worker’s injury, issue benefit checks in accordance to statutory requirements, and demonstrate proficiency in the application of state statutes, related case law and to interpret and comply with company claims standards, policies and procedures.
• Make required filings and ensure benefit payments within the established time frames and guidelines. Prepare, attend, and present a majority of all mediations and hearings. Represent the company at trial.
• Maintain a diary on all open claims. Document all relevant information to provide a clear history of events and a proper audit trail. Set review dates based on claim complexity or standard review criteria.
• Perform other duties as assigned.

Formazione

Bachelor’s Degree

Strumenti

MS Office

Descrizione del lavoro

New Mexico Mutual is seeking a Claims Adjuster Professional Trainee in Albuquerque, NM. The role is designed as a one-year program to introduce the candidate to the workers' compensation claims function under direct guidance from the claims training manager and other management personnel.

During the training, you will engage in claim investigation, determine compensability, analyze benefits, and gain exposure to litigation, mediation, and claims resolution.