Claims Adjuster/Senior Claims Adjuster
Independently investigate, evaluate, negotiate, settle and adjust claims in accordance with MD Workers’ Compensation Law and internal Guidelines.
DUTIES AND RESPONSIBILITIES:
- Independently investigates assigned claims, following sound claims handling techniques in accordance with company claim philosophy and standards, and in accordance with the Maryland Compensation Law.
- With limited assistance from unit supervisor, reviews all relevant data, evaluates claims, determines coverage and compensability and negotiates within settlement authority.
- Documents files with necessary reports, investigative notes, and other data as may be required by the Maryland Workers’ Compensation Law, the company and the unit supervisor. Keeps unit supervisor advised on status of problem claims.
- Prepares files for hearing, develops defense of issues, identifies witnesses and makes decisions regarding appeals.
- Attends hearings, mediations, settlement conferences, pre-trial hearings and fraud trials.
- Provides superior service to policyholders, agents and the claims public. Complies with standards for service and prompt contact. Keeps agents and policyholders informed of claim status as appropriate. Anticipates and promptly responds to all issues and concerns.
- Manages personal caseload effectively in accordance with claims standards.
- Performs other duties as may be dictated by department circumstances.
SKILLS, EDUCATION AND EXPERIENCE:
- Bachelor’s degree and 2 – 4 years claims adjusting experience or 8 years equivalent work experience including 3 years of workers compensation claims adjusting.
- Attainment of AIC certification or comparable certification in insurance.
- Knowledge of claims basics including administrative, procedures and processes, law, reserving, investigation, calculation of benefits, case management, fraud, subrogation, etc.
- Must be a detail-oriented, flexible self-starter, with excellent written and verbal communication skills, capable of handling multiple tasks in a challenging environment.
- Bilingual skills strongly preferred.
- Bias for Action
- Deliver Results
- Personal Leadership
- Knowledge Sharing
- Service and Sales Excellence
- Teamwork and Communication
While performing the duties of this job, the employee is regularly required to sit, use hands and fingers, handle or feel objects, tools or controls; reach with hands and arms. The employee is occasionally required to stand, walk, stoop, kneel, crouch or crawl. The employee may occasionally lift up to 30 pounds. Specific vision abilities are required which include, close vision, peripheral vision and the ability to adjust focus.
Office environment. The noise level is usually moderate.
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