Workers Comp Claims Adjuster

3 weeks ago

Metairie, United States The Gray Insurance Company Full time
DUTIES AND RESPONSIBILITIES

  • Verify coverage of assigned claims and oversee the accuracy of claim set-up
  • Ensure timely communication to insureds and claimants with prompt response time to phone calls and emails
  • Investigate new and existing workers' compensation claims to determine compensability of claims (in whole and in part) and entitlement to indemnity and medical benefits
  • Ensure timely payments of claim bills (medical, legal, vendor) and indemnity payments
  • Establish a thoughtful approach to mitigate exposure with recommendations to management
  • Effectuate timely offers and settlements and ensure timely file closure
  • Ensure accurate and updated file information
  • Complete timely reports and file diaries
  • Visit assigned insureds periodically. Attend insured meetings and file reviews with insureds
  • Obtain medical reports and employer investigation documents. Secure statements from claimants/witnesses
  • Review and Approve/Deny timely, requests for authorization of medication and medical procedures/supplies
  • Schedule IME's and SMO's
  • Monitor incoming medical/legal reports and respond accordingly
  • Timely and accurately address reserves based upon the exposure
  • Submit recommendations to the Claims Branch Manager on cases exceeding personal settlement/reserve authority
  • Assign defense counsel upon the approval of the branch manager or VP - Claims.
  • Manage defense counsel and work collaboratively regarding strategy on litigated claims, making sure litigation management and billing guidelines are followed
  • Obtain expert opinions as needed
  • Attend Benefit Review Conferences and Contested Case Hearings required conferences and hearings with defense counsel
  • Obtain Jury/Appeal Bonds from Surety when needed
  • Monitor vendor participation (e.g. case management, vocational rehabilitation, private investigators) and apply gained knowledge/results appropriately
  • Responsible for completing timely and accurate PLN jurisdictional forms and EDI transmittals to the division-applicable governmental agency
  • Investigate and report to appropriate jurisdictions claims involving suspected fraudulent claims
  • Pursue all viable avenues of subrogation
  • Ensure Medicare Section 111 compliance filings and compliance with MSP requirements
  • Obtain required credit hours to maintain adjuster licensing
  • Ensure updated knowledge/application of DWC jurisdictional rules and regulations
  • Mentor, assist, share experience/expertise
  • Assist the Branch Manager as needed
  • Other duties as assigned/ required
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

REQUIRED SKILLS
  • Excellent communication skills with management, employees, and outsiders.
  • Excellent computer skills with knowledge of Microsoft Office Suite or similar software.
  • Ability to work independently with minimum supervision.

  • Property Litigation Supervisor

    4 weeks ago

    Metairie, United States TheBest Claims Solutions Full time

    Our client is looking for a Property Litigation Supervisor to work in their New Orleans office. This candidate will need to have experience with litigated property claims in the state of Louisiana.Required Qualifications:5+ years of supervising experience in homeowners property.Responsible for supervising litigation process in all phases of high complex...

  • Property Litigation Supervisor

    3 weeks ago

    Metairie, United States TheBest Claims Solutions Full time

    Our client is looking for a Property Litigation Supervisor to work in their New Orleans office. This candidate will need to have experience with litigated property claims in the state of Louisiana.Required Qualifications:5+ years of supervising experience in homeowners property.Responsible for supervising litigation process in all phases of high complex...

  • Orthopedic Surgeon Wanted in Louisiana; Partner Track Opportunity

    1 week ago

    Metairie, United States CompHealth Full time

    Posted 4 days agoPermanentNew Orleans, LouisianaQuick Facts Sign-on bonus and loan repayment available Partner track opportunity Fellows and residents are welcome to apply Medical benefits, life insurance, CME time, and retirement package are included Must be board certified or board eligible No call and no weekends for great work/life balance 100%...

  • Orthopedic Surgeon Wanted in Louisiana; Partner Track Opportunity

    6 days ago

    Metairie, United States CompHealth Full time

    Posted 6 days agoPermanentNew Orleans, LouisianaQuick Facts Sign-on bonus and loan repayment available Partner track opportunity Fellows and residents are welcome to apply Medical benefits, life insurance, CME time, and retirement package are included Must be board certified or board eligible No call and no weekends for great work/life balance 100%...

  • Orthopedic Surgeon Wanted in Louisiana; Partner Track Opportunity

    5 days ago

    Metairie, United States CompHealth Full time

    Posted 8 days agoPermanentNew Orleans, LouisianaQuick Facts Sign-on bonus and loan repayment available Partner track opportunity Fellows and residents are welcome to apply Medical benefits, life insurance, CME time, and retirement package are included Must be board certified or board eligible No call and no weekends for great work/life balance 100%...

  • Associate Attorney

    3 hours ago

    Metairie, United States Morris Bart Law Firm Full time

    Company DescriptionMorris Bart Law Firm is a personal injury law firm located in Metairie, LA. We specialize in personal injury settlements and lawsuits, including automobile accidents, workers' comp, premises liability, and mass tort lawsuits. Our firm has expertise in ALL personal injury cases.Role DescriptionThis is a full-time on-site role for an...

  • Revenue Cycle Specialist

    1 week ago

    Metairie, United States i3 Verticals, Inc. Full time

    JOB TITLE: Revenue Cycle Specialist DEPARTMENT: Healthcare Vertical: ACS REPORTS TO: Manager and/or Area Manager SUPERVISORY RESPONSIBILITIES: no JOB LOCATION: Metairie, LA TRAVEL: no SUMMARY OF POSITION: We are seeking a Revenue Cycle Specialist to join our team. The Revenue Cycle Specialist will be responsible for accurately processing medical...

  • Revenue Cycle Specialist

    3 weeks ago

    Metairie, United States i3 Verticals Management Services, Inc. Full time

    Job DescriptionJob DescriptionJOB TITLE: Revenue Cycle SpecialistDEPARTMENT: Healthcare Vertical: ACSREPORTS TO: Manager and/or Area ManagerSUPERVISORY RESPONSIBILITIES: noJOB LOCATION: Metairie, LATRAVEL: noSUMMARY OF POSITION: We are seeking a Revenue Cycle Specialist to join our team. The Revenue Cycle Specialist will be responsible for accurately...

  • Revenue Cycle Specialist

    4 weeks ago

    Metairie, United States i3 Verticals Management Services, Inc. Full time

    Job DescriptionJob DescriptionJOB TITLE: Revenue Cycle SpecialistDEPARTMENT: Healthcare Vertical: ACSREPORTS TO: Manager and/or Area ManagerSUPERVISORY RESPONSIBILITIES: noJOB LOCATION: Metairie, LATRAVEL: noSUMMARY OF POSITION: We are seeking a Revenue Cycle Specialist to join our team. The Revenue Cycle Specialist will be responsible for accurately...

  • Medical Coding Specialist

    2 weeks ago

    Metairie, United States i3 Verticals Management Services, Inc. Full time

    Job DescriptionJob DescriptionJOB TITLE: Medical Coding Specialist DEPARTMENT: Healthcare Vertical: ACSREPORTS TO: Assistant Manager and/or ManagerSUPERVISORY RESPONSIBILITIES: noJOB LOCATION: Metairie, LA 70001TRAVEL: noSUMMARY OF POSITION: Medical Coding Specialists work weekdays in our comfortable friendly office environment using professional accurate...

  • Billing Specialist

    3 weeks ago

    Metairie, United States Quipt Home Medical Full time

    Job DescriptionJob DescriptionDescription:We are rapidly growing leader in the provision of clinical respiratory equipment, DME and service that is seeking outstanding individuals to join our team of professionals. Due to our success, we are constantly looking for talented and qualified candidates.Position:Billing SpecialistBranch:Access Respiratory...