Sr. Workers Compensation Claims Adjuster (CO Jurisdiction)

Elite Tek Services, Inc.; Denver (CO); Hybrid; USD 80,000 - 90,000; Full time

Job summary

Elite Tek Services, Inc. is seeking an experienced workers’ compensation claims professional to manage a busy caseload and ensure timely investigations and adjudication.

The role involves determining compensability, authorizing medical treatment, calculating reserves, and maintaining clear communication with claimants, providers, and clients while adhering to company guidelines and state laws. Hybrid work arrangement mentioned.

Qualifications

• High School Diploma or GED required.
• Bachelor’s degree in related field preferred.
• Two years related experience preferred.
• Equivalent combination of education and experience.

Responsibilities

• Manages an active caseload of workers’ compensation files (150+).
• Initiates and conducts claims investigation in a timely manner.
• Determines compensability of claims and administers benefits per state law and guidelines.
• Manages medical treatment and medical billing, authorizing as needed.
• Communicates with claimants, providers and vendors regarding claims issues.
• Computes and sets reserves within Company guidelines.
• Maintains diary system for case review and status tracking.
• Reports to clients on claim status and injury trends.
• Adheres to Company policies and procedures.
• Participates in file reviews with clients; handles other jurisdictional claims as needed.

Skills

Analytical skills

Written communication

Verbal communication

Interpersonal skills

Education

High School Diploma or GED

Bachelor’s degree

2 years related experience

Equivalent education/experience

Tools

MS Word

Excel

Job description

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).