Workers' Compensation Sr. Claim Adjuster

Location
Chicago, Illinois
Salary
Salary commensurate with experience. Excellent benefits package with generous PTO bank, 401(k)
Posted
Jun 12, 2018
Closes
Aug 11, 2018
Category
Claims
Job Type
Full Time

Investigates and evaluates losses while developing a plan of action to bring claims to proper resolution in a timely manner. Experience level preferably between 5-7 years.


JOB REQUIREMENTS:

  • Confirms coverage and addresses compensability and causation on each claim
  • Investigates claims, including interviewing employees, employers and witnesses
  • Obtains necessary records, including but not limited to, hospital/physician records, police reports, etc.
  • Responsible for manual and EDI state filings and CMS/Section 111 reporting
  • Utilizes appropriate preferred vendors
  • Presents thorough and accurate reports to clients and excess carriers on claims investigations/status updates
  • Negotiates settlements for resolution with claimants or their attorneys
  • Maintains control of litigation activities and costs per account requirements
  • May be asked to mentor, train and/or share expertise with other ASC staff
  • May be asked to serve as back up to supervisor or manager when they are unavailable
  • Attends meetings; conferences; workshops or training sessions; and reviews written
  • material to maintain current knowledge on principles, practices and new developments in assigned work areas
  • Maintains and meets state specific licensing requirements
  • Responds to client questions and comments in a courteous and timely manner
  • Participates in client meetings, both telephonic and face to face
  • Is responsible for catastrophic losses, complex litigation, and other sensitive issues
  •  All other duties as assigned

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

  • Ability to understand and follow oral and/or written policies, procedures and instructions
  • Ability to perform a wide variety of duties and responsibilities with accuracy and speed, while meeting time-sensitive deadlines
  • Ability to conduct investigations in multi-party situations
  • Ability to use standard or customized software applications appropriate to assigned tasks
  • Ability to prepare and present accurate, reliable and factual reports with recommendations
  • Thorough knowledge of current principles and practices associated with claims investigations, adjustment and related practices
  • Extensive knowledge of medical and legal terminology with a thorough understanding of legal principles/litigation management
  • Ability to handle confidential information
  • Ability to communicate effectively with others both orally and in writing
  • Ability and willingness to learn quickly and utilize new skills as a result of rapidly
  • changing information and/or technology
  • Ability to comprehend multi-state laws and regulations to assist other offices, as necessary


Required Experience:
Should have 5-7 years’ experience in handling  workers’ compensation  claims. A college degree or equivalent business experience needed.