Medical Only Adjuster

4 weeks ago

Austin, United States Service Insurance Companies Full time
Job DescriptionJob Description

**This role is remote, within the United States. Candidates must live in and have authorization to work in the United States. Visa sponsorship not available**

We are searching for a Medical Only Adjuster to join our team

The MO Adjuster investigates, analyzes, and determines the extent of company's liability concerning workers compensation claims and attempt to achieve appropriate claim resolution with claimants and the Division of Workers Compensation – Texas Department of Insurance. They correspond with or interview medical specialists, agents, witnesses, insured’s and/or claimants to compile information and determine claim compensability. Calculate benefit payments and approve payment of claims within your assigned claim authority. All tasks are to be performed with the goal of demonstrating Service Insurance's superior claims handling expertise.

Requirements

  • Under technical direction, works within limits and authority on assignments of higher technical complexity and coordination. Responsible for claims management of assigned cases within guidelines of Company performance standards.
  • Opens new claims, completes three-point contact, and performs needed investigations to determine compensability as well as possible subrogation or apportionment, according to state and/or Service Lloyds timeframes and guidelines.
  • Sets appropriate reserves according to Service Lloyds timeframes and guidelines.
  • Follows appropriate procedures for system documentation to preserve data integrity.
  • Monitors and maintains accuracy of reserves over the life of the claim; when new information is received re-evaluates and recommends reserves according to Service Lloyds standards.
  • Creates and executes action plans needed to bring claims to closure.
  • Completes detailed settlement evaluations or claim resolution plans and recommends appropriate settlement plan of action, within authority; negotiates claim settlements and/or claim resolutions with injured workers and/or injured worker’s attorneys.
  • Prepares accurate, thorough reinsurance reports on claims that meet reporting thresholds.
  • Maintains regular contact with injured workers, insured employers and agents to develop positive relationships and establish credibility.
  • Provides meaningful participation in Large Loss review meetings to improve other departments understanding of claims processes generally and for the specific claim under review.
  • Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
  • Works productively and harmoniously with others on a consistent basis.
  • Responds positively to direction and criticism of performance.
  • Consistently maintain professional and appropriate demeanor.
  • Minimum of (1) year workers’ compensation claims handling experience required.
  • Basic technical workers’ compensation claims knowledge.
  • Strong verbal and written communication skills with emphasis on telephone communication required.
  • Strong math and reading skills required
  • Bachelor’s degree or equivalent combination of training/experience required.
  • Meets all state regulatory standards regarding licensing, continuing education, and other requirements.

Benefits

Service Insurance Companies offers a competitive benefits package, including:

  • Healthcare (medical, dental & vision)
  • Voluntary benefits (life & disability insurance)
  • 401K & profit sharing
  • Generous paid time off & holidays
  • Tuition reimbursement training
  • Pet Insurance

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