Sr. Workers Compensation Claims Adjuster (NM License)

Elite Tek Services, Inc.; Albuquerque (NM); On-site; USD 88,000 - 90,000; Full time

Job summary

Elite Tek Services, Inc. seeks a Sr. Workers Compensation Claims Adjuster (NM License) to manage a large caseload and oversee investigations from filing to resolution.

The role blends in-office collaboration and two days per week in the Albuquerque area. You will determine claim compensability, administer benefits, and coordinate medical treatment and billing while maintaining strong communication with clients, claimants, providers, and vendors.

Qualifications

• Bachelor’s degree in related field; five or more years related experience or equivalent.
• Knowledge of statutory regulations and medical terminology.
• Analytical and written/verbal communication skills.
• Ability to manage very complex claims independently.

Responsibilities

• Manages an average caseload of 130 workers’ compensation files, including complex claims.
• Initiates and conducts investigations in a timely manner.
• Determines compensability and administers benefits per state law and company guidelines.
• Develops and manages claims with action plans toward timely resolution.
• Manages medical treatment and medical billing as appropriate.
• Calculates and pays benefits and approves claim payments.
• References cases to outside defense counsel and directs as appropriate.
• Manages recoveries including deductible and subrogation.
• Communicates with clients, claimants, providers, and vendors.

Skills

Analytical skills

Written communication

Verbal communication

Self-management of complex claims

Microsoft Word

Microsoft Excel

Education

Bachelor’s degree in related field

Tools

Word

Excel

Job description

Position: Sr. Workers Compensation Claims Adjuster (NM License)

Salary: $88,000 to $90,000 (depending on experience)

Type: Hybrid (2-days/wk in-office)

DUTIES AND RESPONSIBILITIES:

• Effectively manages an average caseload of 130 workers’ compensation files, including very complex claims.*
• Initiates and conducts investigation in a timely manner.*
• Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.*
• Develops and manages claims through well-developed action plans; continues to work the action plan to stay on task and to bring the claim to an appropriate and timely resolution.
• Manages medical treatment and medical billing, authorizing as appropriate.*
• Calculates and pays benefits due and approves all claim payments.
• Refers cases to outside defense counsel. Directs and manages as appropriate.*
• Manages claim recoveries of all types, including deductible and subrogation.
• Communicates with clients, claimants, providers and vendors regarding claims issues.*
• Computes and set reserves within Company guidelines.*
• Settles and/or finalizes all claims and obtains authority as designated.*
• Maintains diary system for case review and documents 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.*
• Conducts file reviews independently.*
• Other duties as assigned.

* 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

• Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities

• Technical knowledge of statutory regulations and medical terminology.
• 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.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).
• Knowledge of self-insured claims handling (preferred).
• City, County and/or District claims handling experience (preferred).

Other Qualifications

• New Mexico adjuster’s license required