Sr. Workers Compensation Claims Adjuster (CO Jurisdiction)

Elite; Colorado; Hybrid; USD 80,000 - 90,000; Full time

Job summary

Elite is hiring a Sr. Workers Compensation Claims Adjuster to effectively manage an active caseload of 150 workers’ compensation files, including medical only, indemnity, lifetime medical and permanent partial benefit claims, in a hybrid work setting.

You will initiate investigations, determine compensability, administer benefits, manage medical treatment and billing, communicate with claimants and providers, set reserves, maintain a diary system, and report trends to clients while adhering to

Qualifications

• Education/Experience: High School Diploma or GED required; Bachelor’s degree in related field (preferred); and two (2) years related experience (preferred); or equivalent combination of education and experience.
• Knowledge, Skills and Abilities: Analytical skills; Excellent written and verbal communication skills; Ability to interact with persons at all levels; Proficient in Word and Excel (preferred).

Responsibilities

• Effectively manages an active caseload of 150 workers’ compensation files, including medical only, indemnity, lifetime medical and permanent partial benefit claims.
• Initiates and conducts claims investigation in a timely manner.
• Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Communicates with claimants, providers and vendors regarding claims issues.
• Computes and sets reserves within Company guidelines.
• Maintains diary system for case review and document file to reflect the status and work being performed on the file.
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
• Adheres to all Company policies and procedures.
• Participates in file reviews with clients, as needed.
• Other duties as assigned and including claims management of other jurisdictional workers’ comp claims.

Skills

Analytical skills

Communication skills

Verbal communication

Interpersonal skills

Word

Excel

Education

High School Diploma or GED

Bachelor's degree (preferred)

Tools

Word

Excel

Job description

Job Description

Position: Sr. Workers Compensation Claims Adjuster

Salary: $80,000 to $90,000 (depending on experience)

Type: Hybrid

DUTIES AND RESPONSIBILITIES:

• Effectively manages an active caseload of 150 workers’ compensation files, including medical only, indemnity, lifetime medical and permanent partial benefit claims.*
• Initiates and conducts claims investigation in a timely manner.*
• Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.*
• Manages medical treatment and medical billing, authorizing as appropriate.*
• Communicates with claimants, providers and vendors regarding claims issues.*
• Computes and set reserves within Company guidelines.
• Maintains diary system for case review and document file to reflect the status and work being performed on the file.*
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.*
• Adheres to all Company policies and procedures.
• Participates in file reviews with clients, as needed.
• Other duties as assigned and including claims management of other jurisdictional workers’ comp claims.

*Essential job function.

EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire.

QUALIFICATIONS REQUIRED:

Education/Experience: High School Diploma or GED required; Bachelor’s degree in related field (preferred); and two (2) years related experience (preferred); or equivalent combination of education and experience.

Knowledge, Skills and Abilities:

• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to interact with persons at all levels in the business environment.
• Proficient in Word and Excel (preferred).