[Remote] Workers' Compensation Lost Time Adjuster

Note: The job is a remote job and is open to candidates in USA. Davies North America is at the forefront of innovation and excellence in the insurance sector, seeking a Workers’ Compensation Lost Time Adjuster. The role involves conducting thorough investigations of Workers’ Compensation claims, providing benefits, and ensuring timely state filings while exercising independent judgment and discretion.ResponsibilitiesAdjust claims for assigned Davies North America clientsInvestigate claims by completing 24-hour contact with employee, employer, physician(s), and witnessesEvaluate claim detail, Illinois Statute, and case law to determine compensability and total value of claimDisplay capability of setting and adjusting reserve amounts accordinglyInitiate accurate indemnity payments in a timely manner and maintain diary for ongoing paymentsEnsure timely and proper completion of all required State filingsHandle EDI filings and rejections in conjunction with EDI adjusterMonitor medical treatment in conjunction with the assigned Nurse Case ManagerReview, document and approve medical bills for payment within three days of receiptAuthorize appropriate medical services as appropriateMaintain regular telephone contact with injured employeesDetermine whether vocational rehabilitation services are needed for an employee to return to workCoordinate light duty availability and reasonable accommodations with medical providers and employersMaintain adequate reserves for life of claim utilizing reserve worksheets, ODG Guidelines, Workers’ Computation software, and Davies North America’s reserving philosophyAttend client meetings as necessary, and maintain regular telephone contact to ensure client satisfactionEvaluate cases and negotiate settlements when appropriate, protecting Medicare’s interestsReview claims for possible red flagsIdentify and pursue subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burdenMake timely notice to the excess carrier in all cases while meeting reporting criteria and keeping the carrier updated on claim statusRequest reimbursement at least quarterly and follow up for timely receipt from excess carrier(s)Adhere to client profile instructionsReport any overall account or client concerns to the supervisor or upper managementReport any E&O concernsAttend claims meetings at client locations, client visits, seminars for obtaining CEU creditsInteract with Managers, Training Coordinator, Supervisors, Adjusters, Nurse Case Managers, Team Assistants, Employers, Injured Workers, Medical Providers, Ancillary Providers, State Employees, Insurance Carriers, Excess Carriers, and Brokers as neededSkills1 to 3 years handling Illinois Workers' Compensation claimsMaintain diary and workflow requirementsMaintain 97% claim closure ratioMaintain working knowledge of Illinois Workers' Compensation Statute and Rules, and their applicationCollege degree or equivalent work experienceProactive, independent, and takes initiative with consistent follow throughSuperb communication skills, verbal and written, conducted in a timely mannerSuperior time management skills with capability of working with and meeting deadlinesExceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environmentExcellent team player with interpersonal skillsHigh level attention to detail and problem-solving skillsBenefitsMedical, dental, and vision plans to ensure your health and that of your family.A 401k plan with employer matching to help you build a secure financial future.Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.Paid holidays.Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.Company OverviewWe deliver professional services and technology solutions across the risk and insurance market, including claims, underwriting, distribution, regulation, customer experience, human capital, digital transformation and change management. It was founded in 1984, and is headquartered in San Antonio, Texas, USA, with a workforce of 5001-10000 employees. Its website is http://iasclaims.com.



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