Workers Comp Claims Adjuster II
Absolute Staffing & Consulting Solutions
- Blue Bell, PA
Our Client is seeking to fill one Workers' Compensation Claims Adjuster II positions. Primary office location is in Blue Bell, PA, but work location may be flexible (Blue Bell PA, Wilmington, DE, Mount Laurel NJ).
As a member of the claims team, you will use your knowledge and experience to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.
- Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature
- Determines coverage, compensability and potential for subrogation recovery
- Ensures timely denial or payment of benefits in accordance with jurisdictional requirements
- Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure
- Negotiates claims settlements within granted authority
- Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition
- Works collaboratively with nurse professionals to develop and execute return to work strategies
- Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome
- Maintains a working knowledge of jurisdictional requirements and applicable case law
- Demonstrates technical proficiency through timely, consistent execution of best claim practices
- Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues
- Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account- specific sessions
- Authorizes treatment based on the practiced protocols established by statute or the Managed Care department
- Bachelor's degree and/or three or more years of equivalent work experience required in an insurance related industry required
- Associate in Claims (AIC) Designation or similar professional designation desired
- Familiarity with medical terminology and/or Workers' Compensation
- Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously
- Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
- Strong verbal, written communication skills and customer service skills gained through previous work experience
- Computer literacy, including working knowledge of MS Office Product Suite, i.e. WORD, Excel, PowerPoint
- Ability to travel for business purposes, approximately less than 10%.
- Working knowledge of Workers Compensation regulations for PA.
Please include your salary requirements when responding to this ad.
Monday, October 26, 2020