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Claims Adjuster Trainee
1 month ago
POSITION SUMMARY:
As a workers' compensation Claims Adjuster Trainee you will go through a 24 week paid training program that at which time will be handling a reduced case load. Upon completion, the trainee would transition into a permanent claim adjuster position handling a full case load. Core responsibilities will be; compensability determinations, administration of benefits and ensure ongoing adjudication of claims within company standards and best practices and comply with all statutory and regulatory requirements for the administration of workers compensation benefits on behalf of the Company. Please note: This position will be remote after training period is completed.
KEY RESPONSIBILITIES AND ESSENTIAL FUNCTIONS:
- Complete a 6 week virtual learning training course in conjunction with on the job training.
- Upon completion of the virtual learning and on the job training, handle up to 50 workers' compensation claims for the remainder of the training period.
- Upon completion of the trainee program, there will be a promotion to Claims Adjuster and increase caseload accordingly.
- All new lost time claims require an initial contact with the employer, the injured worker and the medical provider. This must be done within 24 hours of receipt of the claim or notification of a claim.
- Ensure that all claim determinations and payments are completed timely including but not limited to, acceptance/denial letters, wage determination letters including required enclosures and appeal forms. In jurisdictions requiring the letters be provided in Spanish and English the adjuster is responsible to make sure all letters are completed
- The initial payment of TTD is to be completed within 14 days from the receipt of an accepted claim. Wage information is to be solicited from the employer and either an average weekly wage or average monthly (jurisdiction dependent) be established and the information documented in Origami (Claims System). In the event actual payroll documentation cannot be obtained from the employer an "estimated wage" is established and a payment reconciliation is done when the verified wage is secured. Initial compensation benefits should NOT be delayed due to the failure of the employer to provide wage documentation.
- Timely claims determinations for all services including but not limited to: acceptance, denials, authorizations for treatment, benefit payment start, termination are to be included within the statutory or regulatory time frames of the jurisdiction. Denials requiring certified mailing are to be completed timely with appropriate tracking.
- Regulatory notices are to be completed timely when required by jurisdictions.
- Approvals and denials of medical bills should be completed within 24 hours of receipt so bills can be repriced and paid timely.
- Identify the medical providers and medical treatment plan and ensure timely and appropriate medical care is provided to the injured worker. In cases requiring complex or unusual medical care a nurse case manager is to be assigned to facilitate the timely and appropriate care.
- All communications with all parties and reference to all determinations and correspondence are to be included in the claim notes of Origami (Claim System).
- Manage the legal aspects of the claim and appropriately assign and direct designated attorneys.
- Assign claims for investigations, including surveillance, medical surveys and social media checks when required and seek supervisor support on related questions.
- Ensure that all bills for various expenses, including legal bills, managed care bills and similar expenses are paid timely or direct claims assistants to pay such when appropriate.
- Answer phone calls immediately when in the office. Return all calls and voice mail messages with 24 hrs. Respond to all e-mails when required within 24 hrs.
- Direct claims assistants to facilitate adjuster assignments as required. This includes directing clerical staff in duties such as copying documents, scheduling medical appointments for injured workers and filing of documents. Coordinate assignments with the supervisor of the assistants.
- Establish a Plan of Action (POA) on each claim and update the POA monthly.
- Monitor claims for reinsurance/excess insurance reporting and provide initial reports and quarterly updates on all claims meeting reporting requirements.
- Performs other activities, assignments and duties as assigned.
- 20. Handle claims according to our best practices
Requirements
- Bachelor's degree or equivalent education
- 2-3 years' work experience preferred
- Excellent analytical skills
- Strong organizational skills
- Strong oral and written communication skills
Salary Description
$50,000 to $60,000