Overview

We are a high-deductible and self-insured workers’ compensation TPA building a team of excellent adjusters.

Position Overview:

Workers' Compensation Claims Adjuster, Senior

As a Workers' Compensation Claims Adjuster, Senior, you will be responsible for the investigation and adjustment of assigned claims.

Key Details:

• Location: Remote

• Schedule: Monday to Friday, Contract to Permanent

• Types of Accounts: Light Industrial, other Miscellaneous

• Jurisdictions: California (and New York)

• License Required: California Adjuster's License

• License Preferred: New York Adjuster’s License

• Preferred Certifications: SIP/WCCA/WCCP/AIC

·       Computer Skills Required: Proficient in Microsoft Office

·       Computer Skills Preferred: Proficient in ClaimPilot

Responsibilities:

• Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.

• Establish reserves and/or provide reserve recommendations within established reserve authority levels.

• Review, approve or provide oversight of medical and legal estimates and miscellaneous invoices to determine if reasonable and related to designated claims.

• Negotiate any disputed bills or invoices for resolution.

• Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.

• Negotiate settlements in accordance with best practices, client specific handling instructions and state laws, when appropriate.

• Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)

• Review and maintain personal diary on claim system.

• Assess and monitor subrogation claims for resolution.

• Prepare reports detailing claim status, payments and reserves, as requested.

• Provide notices of qualifying claims to excess/reinsurance carriers.

• Conduct claim reviews and/or training sessions for clients, as requested.

• Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.

• Administer benefits on claims.

• Ensure timely utilization review (UR) processing.

• Process bills promptly.

• Communicate effectively with injured workers, clients, and attorneys.

• Maintain proper documentation of the claim file in a timely manner.

• Provide summary updates every 30, 60, or 90 days.

• Drive claims to resolution.

• Performs other duties as assigned.

Qualifications:

• Excellent oral and written communication skills.

• Initiative to set and achieve performance goals.

• Good analytic and negotiation skills. 

• Ability to cope with job pressures in a constantly changing environment. 

• Knowledge of all lower level claim position responsibilities.

• Must be detail-oriented and a self-starter with strong organizational abilities. 

• Ability to coordinate and prioritize required. 

• Flexibility, accuracy, initiative and the ability to work with minimum supervision. 

• Discretion and confidentiality required. 

• Reliable, predictable attendance within client service hours for the performance of this position. 

• Responsive to internal and external client needs. 

• Ability to clearly communicate verbally and/or in writing, both internally and externally.

Performance Metrics:

• Timely payment of benefits with no self-imposed penalties.

• Keeping diaries and mail up to date.

• Appropriately reserving files for the most probable outcome.

Education and/or Experience:   

• 5+ years of experience as a claims examiner handling semi-complex to complex-level claims.

• Strong analytical and problem-solving skills.

• Excellent communication and negotiation abilities.

• Ability to work independently and manage multiple priorities.

Please apply to: lauren@fairbanksclaims.com

Please visit our website for more information: http://www.fairbanksclaims.com/