WC Claim Adjuster
Investigates and analyzes claims. Determines coverage and negotiates settlement with claimants. Minimum experience level should be between 3-5 years.
- 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
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.
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