Medical Only Work Comp Claims Adjuster
**This position can be remote**
Summary: Under moderate supervision and following standard procedures with some independent judgment, investigates, evaluates and resolves/disposes of medical only workers compensation claims to determine the extent of company liability; may include determination and evaluation of coverage, compensability, liability and damage in accordance with policy provisions by performing the following duties.
Essential Duties and Responsibilities:
Follows corporate policies, procedures, and fair claims handling practices
Investigates claims to determine validity and extent of liability, including:
Obtains information necessary to properly investigate and evaluate each case by corresponding with agents, insureds, claimants, witnesses and others
Reviews and evaluates documentation, including applications, reports, and statements
Monitors appropriate claim outcomes through self-audit process
Delivers superior customer service to policyholders and agents, ensuring appropriate and timely resolution of claims service issues
Ensures legal, regulatory and fair claims handling compliance
Sets or recommends reserves based on results of claim investigation.
Within defined authority, manages, evaluates and concludes claims. Prepares and maintains claim reports.
May provide interaction with insureds, agents, claimants, attorneys, and other service providers, including:
Conducts in-depth interviews and/or scene inspections
Attends settlement conferences and/or trials
May serve as a member of project teams, contributing to the achievement of project objectives.
Performs other duties as assigned.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience:
Level 4: Two to four years related experience and/or training; or associate's degree (A.A.) from two-year college/technical school; or equivalent combination of education and related experience/training.
A minimum requirement for this position is the ability to work legally in the United States. No visa sponsorship/support is available for this position, including for any type of U.S. permanent residency (green card) process.
Apply To This Job
Summary: Under moderate supervision and following standard procedures with some independent judgment, investigates, evaluates and resolves/disposes of medical only workers compensation claims to determine the extent of company liability; may include determination and evaluation of coverage, compensability, liability and damage in accordance with policy provisions by performing the following duties.
Essential Duties and Responsibilities:
Follows corporate policies, procedures, and fair claims handling practices
Investigates claims to determine validity and extent of liability, including:
Obtains information necessary to properly investigate and evaluate each case by corresponding with agents, insureds, claimants, witnesses and others
Reviews and evaluates documentation, including applications, reports, and statements
Monitors appropriate claim outcomes through self-audit process
Delivers superior customer service to policyholders and agents, ensuring appropriate and timely resolution of claims service issues
Ensures legal, regulatory and fair claims handling compliance
Sets or recommends reserves based on results of claim investigation.
Within defined authority, manages, evaluates and concludes claims. Prepares and maintains claim reports.
May provide interaction with insureds, agents, claimants, attorneys, and other service providers, including:
Conducts in-depth interviews and/or scene inspections
Attends settlement conferences and/or trials
May serve as a member of project teams, contributing to the achievement of project objectives.
Performs other duties as assigned.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience:
Level 4: Two to four years related experience and/or training; or associate's degree (A.A.) from two-year college/technical school; or equivalent combination of education and related experience/training.
A minimum requirement for this position is the ability to work legally in the United States. No visa sponsorship/support is available for this position, including for any type of U.S. permanent residency (green card) process.
Apply To This Job