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We are seeking an experienced workers compensation adjuster toprovide front-line customer-focused handling of lost time complex claims for an assigned market. Leverage your industry experience and join our expanding team in thisWorkers Compensation Claims Adjusterrole.
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Managing a portfolio of commercial line products including property, liability, and workers' compensation insurance. Strong understanding of commercial insurance products and the ability to articulate complex insurance concepts in simple terms.
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Additional Preferred Skills: Experience in Visual Basic and Access for legacy application migration is a plus Experience with the healthcare industry and workers' compensation is a plus. Responsible for designing, coding, testing, and debugging robust and complex database-driven applications using C#, WCF, MVC, Razor and T-SQL, with Visual Basic and Access experience a plus for legacy application migration.
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Description: PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
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The successful candidate will have multiple state licenses, past Medical Director experience, understand Workers Compensation laws throughout the US, and know various state Workers Compensation treatment guidelines.
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Excellent documentation skills in order to plan, create, track and sustain software engineering work. Experience with ASP.NET MVC framework using (Razor syntax is a plus) Excellent programming skills in C# and T-SQL, with at least 4-6 years' experience.
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Market-driven compensation and bonus plan. Our team does their best work each day, creating a one-stop resource for all commercial insurance solutions and construction safety resources, leading to powerful results.
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Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
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To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.
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FL or reciprocal state adjuster license required; other licenses in our footprint are a plus. Earn swag and extra time off through peer recognition Builders Bucks program. Handle all aspects of investigation and settlement of assigned claims to include interviewinginsureds, claimants, witnesses, and physicians; evaluating and making recommendations regarding coverage of claims; determining liability and the total value of claims; negotiating settlements and making recommendations regarding litigation.
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Workers Compensation Claims Examiner (3 years of California WC experience) Category Name: Claims Examiner - Workers Compensation. Claims Examiner - Workers Compensation (1248943.
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Coordinates vendor referrals for additional investigation and/or litigation management. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
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Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
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Manages the litigation process; ensures timely and cost effective claims resolution. Must have SIP Certification. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
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This adjuster will be responsible for all aspects of coverage, investigation, negotiation, and resolution within established best practices while utilizing independent judgment in decision-making and managing the claim in a prompt and thorough manner from inception through closure.
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