Claims Adjuster - Workers Comp - Senior
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.
- 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.
- Refer all files identified with subrogation potential to the subrogation department.
- 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.
- 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.
- Report all serious injuries/liability issues & potential large loss claims to client and/or reinsurer based upon the criteria provided by the client.
- 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.
- 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.