Senior Claims Adjuster

Position Overview 

It is the responsibility of a workers’ compensation claims adjuster to receive and organize all documents related to the employee and the injury in order to make a determination regarding the claim. Workers’ compensation claims adjusters abide by company guidelines when making claim determinations.
This role requires excellent communication and customer service skills, strong motivation and works in a team environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Responsibilities

• Investigates and maintains worker’s compensation claims. Reviews and evaluates coverage and/or liability. Secures necessary information (i.e., reports, policies, releases, statements or other documents) in the investigation of claims.
• Works toward the resolution of claims files, and attends arbitrations, mediations or trials as necessary. Takes full charge of claim from start to resolution.
• Will affect settlements/reserves within prescribed limits and submits recommendations to supervisor on cases exceeding personal authority.
• Ensures that claims payments are issued in a timely and accurate manner.
• Ensures compliance of claims handling pursuant to all state, legal, statutory and regulatory bodies to comply with all company procedures and requirements.
• Maintains a diary to follow claim progress on all claims.
• Must obtain state adjusting licenses where required.

Qualifications

• 3-5 years of experience handling worker’s compensation claims experience.
• State specific licensing, worker’s compensation
• Familiarity with state and federal workers’ compensation laws and regulations
• Multiple jurisdiction experience is preferred.
• Candidates will be required to have strong skills in customer service, verbal and written communications, time management, and organizational skills.
• Great attention to detail
• Must demonstrate an ability to work independently.
• Must demonstrate a strong knowledge of computers and software.
• Must have experience in adjusting in CA claims and other states is a plus

Communication Skills

Effective with making complex technical information and recommendations understandable and clear to audiences with varied levels of technical knowledge Listens effectively Clearly expresses ideas, recommendations, etc. in writing.

Technical Expertise

• Complete understanding of all Microsoft Office applications relevant for their area and navigates large volumes of loss data and creates presentable summaries.
• Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of formulas and equations.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Reviews loss information to identify basic trends and recommendations.
• Handles multiple assignments and schedules accordingly in order of importance

Customer Service

• Responds timely and consistently with all communication.
• Builds credibility with internal and external customers.
• Creates customer satisfaction by demonstrating the value of risk management Familiar with the company tools and is comfortable reviewing with all levels of management.

Physical Work Demands

• Seeing/General and Close Vision
• Hearing/Listening
• Clear Speech- Complete
• Touch: Dexterity, Hand, Finger, Repetitive Key Typing
• Lifting up to 10 pounds
• Pushing and Pulling
• Bending
• Sitting

Travel

Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected to attend sales conferences.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice