Claims Adjuster - Workers Comp - Senior

Employer
NARS
Location
Altamonte Springs, Florida
Salary
N/A
Posted
Jan 23, 2018
Closes
Mar 24, 2018
Category
Claims
Job Type
Full Time
Career Level
Manager

Essential Duties & Responsibilities:

  • Identify, analyze and confirm coverage.
  • Knowledge in Florida workers compensation and with a willingness to learn additional jurisdictions.
  • Preference is for position to be based in Arizona or Florida. Must provide proof of active licensing or certification for Florida.
  • Must have 3+ years prior claim adjusting or similar experience, to include handling of complex litigation.
  • Must have 5 to 7 years of overall claims experience in Workers Compensation.
  • Must be eligible for reserve/payment authority level of $50,000+ when appropriate
  • Must possess required Adjuster’s license(s) with the ability to obtain other required jurisdictional licensing. Handle a caseload of approximately 130 pending claims encompassing all levels of complexity.
  • Requires establishing facts of loss, coverage analysis, investigation, compensability/liability/negligence determination, coordination of medical care, litigation management, damage assessment, settlement negotiations, identifying potential fraud & appropriate use of authorized vendors.
  • Includes timely & appropriate reserve analysis & report completion.
  • Ability to attend conferences, client meetings, mentor other adjusters & assist management as requested.
  • File handling must be within state statutes, Client Claims Handling Guidelines & NARS Best Practices.

Customer Service/Contact:

  • Contact appropriate parties & providers to determine liability, compensability, negligence & subrogation potential.
  • Contact appropriate parties to obtain any needed information & explain benefits as appropriate. Continue contact during life of file as appropriate.
  • Answer phones, check voice mail regularly & return calls as needed. Assist with training/mentoring of Claims Adjusters.
  • Assist management when required with projects or leadership as requested.
  • Handle the various duties/responsibilities of Unit Manager as delegated in their absence.

Subrogation:

  • Refer all files identified with subrogation potential to the subrogation department.

Investigation:

  • Verify facts of loss & pertinent claims facts such as employment, wages, or damages & establish disability with treating physicians as appropriate. Identify cases for settlement.
  • Evaluate claims & request authority no later than 30 days prior to mediation date & negotiate settlement.

Litigation Management:

  • Develop & direct litigation plan with defense attorney, utilizing all defenses & tools to bring file to closure.
  • Ensure all filings & state mandated forms are completed timely.
  • Litigated files must be diaried effectively based on current activity, no greater than every 60 days.
  • Review claim files involving active litigation monthly at minimum, document responses to filings, development of defenses, depositions, & timely referral to defense counsel.

Reporting Requirements:

  • Report all serious injuries/liability issues & potential large loss claims to client and/or reinsurer based upon the criteria provided by the client.

Technical skills:

  • Advance level of interpersonal skills to handle sensitive/confidential situations & information.
  • Requires advanced ability to negotiate claims & direct litigation. Must have negotiation and litigation skills for significant work with attorneys.
  • Requires advanced ability to work independently, an advanced level of organization, time management skills & advanced level written & verbal communication skills.

Abilities:

  • Requires long periods of sitting, working indoors in environmentally controlled conditions, lifting of files/boxes up to 20#, use of keyboard/mouse & exposure to computer screens, travel as assigned.

Similar jobs

Similar jobs