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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
License Required: California Adjuster's License
Preferred Certifications: SIP/WCCA/WCCP/AIC
Computer Skills Required: Proficient in Microsoft Office
Computer Skills Preferred: Proficient in ClaimPilot
Spanish Speaking Preferred
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/
