Claims - TN Workers Compensation Claims Adjuster
Our TN Workers Compensation Claims Adjuster will, with limited supervision, promptly and effectively evaluate, and negotiate claims within the adjuster’s authority and following clients’ procedures.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Main Job Tasks and Responsibilities:
Below is a brief outline of the main responsibilities of this position:
- Review, examine, investigate, and analyze workers’ compensation claims.
- Interact with injured employees to ensure awareness and understanding of the workers’ compensation process, requirements, and entitlements.
- Prepare and issue notices in accordance with mandated requirements and regularly review and stay abreast of applicable laws that may impact how claims are processed.
- Establish claim reserve levels by estimating the cost of each assigned claim and monitor reserves and update amounts as necessary.
- Coordinate medical treatment for injured employees and provide information to treating physicians regarding employee’s medical history, health issues, and job requirements.
- Identify subrogation potential and pursue the process of reimbursement.
- Serve as a liaison between medical providers, employees, legal professionals, and other entities.
- Inform departments of an injured employee’s work restrictions and coordinate appropriate accommodations.
- Review and interpret doctor’s reports to ensure that the appropriate American Medical Association (AMA) guidelines have been applied when reporting disability, impairment, and apportionment.
- Compare and reconcile claim records with client's payroll records to ensure timely and accurate benefit payments; retrieve workers’ compensation usage information from the financial system, review timesheets, and resolve discrepancies.
- Communicate with defense attorneys regarding litigated cases and make recommendations regarding proposed strategies for claim resolution.
- Prepare legal documents for submission to the Workers’ Compensation Appeals Board, attend Board hearings, and respond to requests for clarification, as necessary.
- Analyze, compute, and process indemnity payments and audit incoming invoices for accuracy and process payments.
- Assist with the Request for Proposal (RFP) process for contracted services and participate in researching, interviewing, and selecting outside vendors.
- Attend and participate in staff meetings and keep supervisor informed of status on all assigned cases and plan of action and stay abreast of new trends, pending legislation, and case law related to workers’ compensation.
- Perform other duties as assigned by Management.
Required Education and Experience:
- High school diploma required.
- Valid adjuster's license required, if applicable.
- A minimum of three years of claims experience with AIC or CPCU designation preferred.
- Excellent written and oral communication skills required.
- Ability to prioritize daily workflow of a moderate technical complexity is necessary.
- Ability to work independently and with initiative is essential.
- Knowledge of relevant software applications including MS Office (Word, Excel, and Outlook) preferred.
We are seeking a candidate who lives in the State of Tennessee and is familiar with TN workers' compensation law.
This position is primarily performed in a typical office setting. Remote work opportunity is available.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is frequently required to write, type, file and lift various items up to 25 pounds. The employee is frequently required to stand, speak, listen, and hear.
This is a full-time position with benefits.
Please note that our company will only notify applicants chosen to schedule an interview for the position.
Collins & Company, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, our company complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Job Type: Full-time
Pay: $40,000.00 - $55,000.00 per year
- 401(k) matching
- Dental insurance
- Disability insurance
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
- 8 hour shift
- Day shift
- Monday to Friday
All customers are required to wear a mask, and common surfaces are sanitized regularly.
- High school or equivalent (Required)
- WC Claims Adjusting: 3 years (Preferred)
- Fully Remote
This Job Is Ideal for Someone Who Is:
- Adaptable/flexible -- enjoys doing work that requires frequent shifts in direction
This Company Describes Its Culture as:
- People-oriented -- supportive and fairness-focused
- Remote interview process
- Social distancing guidelines in place
- Virtual meetings
- Sanitizing, disinfecting, or cleaning procedures in place