Senior Claims Adjuster

Cross Insurance; Augusta (ME); On-site; USD 45,000 - 65,000; Full time

Job summary

The Cross Insurance family seeks a skilled Claims Adjuster in Maine to evaluate information for compensability and negotiate settlements while maintaining professional service to insureds and providers.

Ideal candidates have at least 3 years of Maine Workers’ Compensation claim adjusting or paralegal experience, with an active Maine adjuster license, and strong organizational, analytical, and communication skills.

Qualifications

• High school diploma required; BA/BS preferred.
• Minimum 3 years Maine Workers’ Compensation claim adjusting or paralegal experience.
• Maine Workers’ Compensation adjusters’ license required.
• Strong organizational, mathematical accounting aptitude; analytical, problem-solving abilities.
• Excellent interpersonal, tactful, diplomatic communication.

Responsibilities

• Gains basic knowledge of Department Errors and Omissions Exposures and implementation of Department E&O Procedures.
• Ensures optimum performance in this function and recommends and implements techniques to increase productivity or department procedures.
• Develops and maintains an image of corporate excellence and teamwork with emphasis on professional and credible customer service and company relations.
• Accurate claims adjudication by assessing all information to determine compensability.
• Reviews and authorizes payments and complies with state mandated and contractual requirements.

Skills

Interpersonal skills

Analytical problem solving

Communication skills

Negotiation skills

Education

Bachelor's degree preferred

High school diploma required

Maine Workers’ Compensation adjuster license

Job description

The Cross Family of Agencies welcomes you. We need your talent and expertise.

POSITION: Claims Adjuster

DEPARTMENT: Claims Management Division

REPORTS TO: Manager - Claims Management Division

Position Requirements:

• High school graduate required; BA/BS degree preferred.
• Minimum 3 years Maine Workers’ Compensation claim adjusting or paralegal experience necessary.
• Maine Workers’ Compensation adjusters’ license required.
• Highly developed organizational skills and ability to establish priorities. Mathematical/accounting aptitude and excellent analytical, problem-solving abilities required. Ability to anticipate needs and exercise independent judgment.
• Strong interpersonal skills to deal effectively with all levels of the organization, the public and customers with tact and diplomacy

Primary Accountabilities:

• Gains basic knowledge of Department Errors and Omissions Exposures and implementation of Department E&O Procedures.
• Ensures optimum performance in this function and recommends and implements techniques to increase productivity or department procedures.
• Develops and maintains an image of corporate excellence and teamwork with emphasis on professional and credible customer service and company relations.

Accurate claims adjudication by assessing all information to determine compensability:

• Effective communication and negotiation skills
• Creative analytical problem solving skills
• Ability to manage multiple priorities in a fast paced and dynamic environment
• Ability to speak and present to various sized groups
• Interfaces with Self Insured Management Team, claims management division personnel, insureds, health providers and attorneys. Partners with employer in effective claims management.
• Reviews and authorizes payments.
• Complies with all state mandated and contractual requirements.

Positive and effective co-worker relations:

• Focus on team goals and objectives
• Courteous and considerate communications
• Accurate assistance and support to others as needed.