Senior Claims Adjuster
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.
- 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.
- 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 MA, NJ claims and other states is a plus
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.
- 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
- 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
- Clear Speech- Complete
- Touch: Dexterity, Hand, Finger, Repetitive Key Typing
- Lifting up to 10 pounds
- Pushing and Pulling
Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected to attend sales conferences.
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.