Senior Workers Comp Claims Adjuster- Must have Florida Experience

North American Risk Services (NARS); United States; On-site; USD 60,000 - 90,000; Full time

Job summary

North American Risk Services (NARS) is seeking an experienced Claims Adjuster to handle a caseload commensurate with complexity. You will establish facts of loss, analyze coverage, investigate, and determine compensability, liability, and negligence. The role includes coordinating medical care, managing subrogation, and communicating with clients throughout the claim lifecycle.

Travel may be required. You will mentor other adjusters, support management on projects, and ensure compliance with

Qualifications

• Experience handling complex claims with coverage determinations.
• Ability to travel as needed.
• Strong analytical and negotiation skills to resolve claims promptly.

Responsibilities

• Identify, analyze, and confirm coverage for claims.
• Investigate loss facts and determine compensability and liability.
• Coordinate medical care and manage litigation as appropriate.
• Negotiate settlements and assess damages.
• Manage subrogation potential and vendor relationships.
• Maintain claim metrics and comply with guidelines.
• Support leadership and mentor other adjusters.
• Travel as required.

Skills

Coverage analysis

Investigation

Liability assessment

Negotiation skills

Medical coordination

Vendor management

Reserve analysis

Communication

Job description

Handle a caseload commensurate with the complexity level of claims assigned. Requires establishing facts of loss, coverage analysis, investigation, compensability/liability/negligence determination, coordination of medical care (as appropriate), litigation management, damage assessment, settlement negotiations, identifying potential fraud, vendor management, reserve analysis, and report completion. Ability to attend conferences, client meetings, mentor other adjusters and assist management as needed. Ensure compliance with state statutes, client guidelines and NARS Best Practices. Address claim metrics in a timely and appropriate manner. Perform other miscellaneous duties as assigned, which may include travel.

Essential Duties and Responsibilities:

Coverage:

• Identify, analyze, and confirm coverage.

Customer Service/Contact:

• Make contact first within parties and clients within eight (8) business hours.


• Communicate with parties and providers to determine liability, compensability, negligence, and subrogation potential.


• Obtain necessary information and explain benefits as appropriate. Maintain regular contact throughout the life of the claim process.


• Answer phones, check voice mail regularly, and return calls as needed.


• Assist with training/mentoring of Claims Adjusters.


• Assist management when required with projects or leadership as requested.


• Support management and handle various duties/responsibilities of the Assistant Unit Manager/Unit Manager as delegated in their absence.

Subrogation:

• Refer all files identified with subrogation potential to the subrogation department.


• Maintain closing ratio as dictated by management team.


• Close all files as appropriate in a timely and complete manner.


• Verify facts of loss and pertinent claims facts such as employment, wages, or damages and establish disability with treating physicians as appropriate