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Claims Adjuster

Employer
Davies Claims Solutions
Location
Nashville, Tennessee
Salary
Not specified
Closing date
Mar 20, 2021

View more

Category
Claims
Job Type
Full Time
Career Level
Experienced (Non-Manager)

Job Details

Investigates and evaluates losses while developing a plan of action to bring claims to proper resolution in a timely manner. Experience level preferably between 3 - 5 years.

JOB REQUIREMENTS:

· Determines extent of insurance coverage and compensability for new claims,

presumption claims and pensioner claims

· Investigates claims, including interviewing employees, employers, witnesses

· Obtains necessary records, including but not limited to, hospital records, police

reports, physician records, etc.

· Utilizes appropriate preferred vendors

· Monitors/directs medical treatment

· Handles Medicare subrogation issues

· Presents thorough and accurate reports to clients

· 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

· 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

· 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

· Will work onsite at local office as well as onsite with client

Required Experience:

Should have 3 - 5 years experience in handling workers’ compensation claims. A college degree or equivalent business experience needed.

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.

 

Company info
Website
Location
2501 McGavock Pike, Suite 802
Nashville
TN
37214
US

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