Lost Time Claims Adjuster – Workers' Compensation

Responsibilities

• Manage lost time and medical only Workers' Compensation claims.
• Evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims.
• Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines.
• Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision.
• Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed.
• Utilize proactive reserving behaviors to ensure adequate case reserves.
• Consults with assigned claim director, return to work specialists, nurse case managers, and internal/external medical professionals.
• Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs.

Requirements

• Bachelor’s Degree from an accredited college or university is preferred.
• Three years of experience in the field of workers’ compensation insurance required.
• Ability to manage claims through the litigation process.
• One valid workers’ compensation adjuster license is strongly preferred.
• Preference may be shown to candidates with multiple state claims management experience.
• Experience in workers’ compensation claims practices and laws, court procedures, precedents, and state statutes.
• Ability to use logic and sound reasoning to identify alternative solutions for problem-solving.
• Strong written and verbal communication skills.
• Strong analytical skills.
• Ability to multitask and manage time effectively and productively.