Lost Time Claims Adjuster

Spencer Reed Group; Kansas City (MO); On-site; USD 65,000 - 90,000; Full time

Job summary

Spencer Reed Group in Kansas City, MO is seeking a Lost Time Claims Adjuster to manage investigations, lost time benefits, surgery, and settlements. You will interact with policyholders, employers, medical providers, and attorneys to advance claims.

This role involves timely three-point contacts, setting reserves, reviewing bills, coordinating with nurse case managers and defense counsel, and ensuring compliance with state statutes.

Qualifications

• Provide thoughtful & thorough written correspondence both internally and externally.
• Accountability for meeting various deadlines related to the responsibilities of the position and managing various tasks throughout the day.
• A proactive approach to claims handling; a result-oriented individual.
• Embraces the core values of our organization.
• Attention to detail.
• Ability to communicate often and effectively with supervisor and peers.

Responsibilities

• Expeditiously investigates assigned claims to determine compensability to aid in prompt administration of benefits.
• Make three-point contacts to employer, employee, and medical provider within 24 hours of claim assignment (business days).
• Obtains claim exposure to set appropriate reserves; reviews and adjusts throughout the life of the claim as appropriate.
• Reviews and processes bills in a timely manner.
• Communicates timely updates to employers throughout the life of the claim.
• Timely respond to incoming calls and emails from employers, medical providers, any parties involved in claim.
• Controls and directs vendors to aid in the progression of care.
• Regularly reviews and updates claim status reports as facts of the claim change.
• Reviews impairment rating with claimant and negotiates settlement for claim resolution.
• Works with attorneys to manage legal settings, filings, etc.
• Obtains and documents all necessary forms per state statute.
• Anticipate challenges that could impact outcome of claim and mitigate exposure.
• Assists in covering teammates desks including incoming claims, mail, calls, and emails as needed.
• Facilitates subrogation proceedings on claims involving third-party negligence in an effort to obtain maximum recovery.
• Respond to questions from Compliance Department to ensure accurate state filings.
• Communicates with agency partners to provide claim updates, facilitate claim reviews, and maintain relationship with mutual insured.
• Review claim file to ensure all bills are paid and task to close claim in timely manner

Skills

Written communication

Accountability

Proactive approach

Attention to detail

Tools

Nurse case management coordination

Legal/claims negotiation

Job description

The Lost Time Claims Adjuster plays a critical role in our connections and interactions with our policyholders and agency partners. They are involved in handling claims that require investigation, lost time benefits, surgery, litigation, and negotiation of settlements.

Lost Time Claims Adjusters interact with multiple departments within XXXX to provide quality claims handling and mitigate exposure on claims. This includes working with Loss Control to determine when on-site accident investigations are appropriate and collaborating with Account Managers to address the needs of our policyholders and agency partners.

Essential Functions:

• Expeditiously investigates assigned claims to determine compensability to aid in prompt administration of benefits
• Make three-point contacts to employer, employee, and medical provider within 24 hours of claim assignment (business days)
• Obtains claim exposure to set appropriate reserves; reviews and adjusts throughout the life of the claim as appropriate.
• Reviews and processes bills in a timely manner
• Communicates timely updates to employers throughout the life of the claim
• Timely respond to incoming calls and emails from employers, medical providers, any parties involved in claim
• Controls and directs vendors (i.e. nurse case managers, attorneys) to aid in the progression of care
• Regularly reviews and updates claim status reports as facts of the claim change (i.e. reserve changes, significant medical updates, etc.)
• Reviews impairment rating with claimant (when applicable) and negotiates settlement for claim resolution
• Works with attorneys to manage legal settings, filings, etc.
• Obtains and documents all necessary forms per state statute
• Anticipate challenges that could impact outcome of claim and mitigate exposure
• Assists in covering teammates desks including incoming claims, mail, calls, and emails as needed
• Facilitates subrogation proceedings on claims involving third-party negligence in an effort to obtain maximum recovery
• Respond to questions from Compliance Department to ensure accurate state filings
• Communicates with agency partners to provide claim updates, facilitate claim reviews, and work closely to maintain successful/exceptional relationship with mutual insured
• Review claim file to ensure all bills are paid and task to close claim in timely manner

Qualifications:

• Provide thoughtful & thorough written correspondence both internally and externally.
• Accountability for meeting various deadlines related to the responsibilities of the position and managing various tasks throughout the day
• A proactive approach to claims handling; a result-oriented individual.
• Embraces the core values of our organization
• Attention to detail
• Ability to communicate often and effectively with supervisor and peers.