WC Claim Adjuster
- Employer
- Davies Claims Solutions
- Location
- Irving, Texas
- Salary
- Salary commensurate with experience. Medical, dental, vision, 401(k), generous PTO bank and more.
- Closing date
- Nov 1, 2019
View more
- Category
- Claims
- Job Type
- Full Time
- Career Level
- Experienced (Non-Manager)
Job Details
SUMMARY
Workers Comp Adjuster investigates and analyzes claims. Determines coverage and negotiates settlement with claimants. Minimum experience level should be between 3-5 years.
JOB REQUIREMENTS:
- Determines extent of insurance coverage and compensability on each filed claim
- Investigates claims, including interviewing employees, employers, witnesses
- Obtains necessary records, including but not limited to, hospital records, police reports, physician records, etc.
- Utilizes appropriate vendor for medical bill review
- Presents thorough and accurate reports to clients and excess carriers on claims investigations/situations
- Negotiates settlements for resolutions with claimants and their attorneys
- 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
- 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 operate a personal computer using standard or customized software applications appropriate to assigned tasks
- Ability to prepare and present accurate and reliable reports containing finding and 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
- 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
Required Experience:
Should have minimum of 3-5 years of experience in handling workers’ compensation claims. A college degree or equivalent business experience needed. Texas Non-Subscribers claims handling is a plus.
Company
Davies Claims Solutions provides TPA services for a variety of insurance clients and self-insured entities including public entities and private employers with employees in many states.
The workers’ compensation TPA claims handling process includes a number of services such as nurse case management, nurse triage, medical bill review, pharmacy benefit management, telemedicine, medical provider options, return-to-work initiatives, peer review, utilization review and more.
As a TPA, we provide a number of flexible client options, such as choice of nurse case management, medical provider access with PPO networks or Alternative Cost Containment, and a choice of surveillance and claims investigation. We also offers telemedicine as a managed care solution.
Our U.S. claim adjusters, have an average of 25 years of industry experience. We have a strong track record of delivering excellent financial outcomes for our clients such as averaging indemnity savings of almost a third through our pharmacy benefit management.
- Website
- http://www.ascrisk.com/
- Location
-
2501 McGavock Pike, Suite 802
Nashville
TN
37214
US
Get job alerts
Create a job alert and receive personalized job recommendations straight to your inbox.
Create alert