Claims Adjuster II

3 days ago

Henderson NV United States EMPLOYERS Full time
Job Summary

The Claims Adjuster II is a key role within our organization, responsible for the timely and accurate management of workers' compensation claims with moderate medical and indemnity benefit exposure, including litigation.

Key Responsibilities
  • Initial Contact and Claim Management: Completes initial contacts to obtain necessary additional information, verify coverage, determine compensability, and develop a plan of action. Maintains accurate claim system data.
  • Case Analysis and Reserve Management: Analyzes case facts to establish timely and accurate case reserves using knowledge of medical disabilities and related costs, as well as judgment of extent of disability.
  • Customer Service and Communication: Provides timely and appropriate customer service within established best practices. Maintains ongoing professional communications with all internal and external customers.
  • Benefits Evaluation and Payment: Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines. Files appropriate state forms, as needed.
  • Medical Treatment Coordination: Proactively coordinates and monitors medical treatment to continue to move the claim forward. Uses resources, internal and external, to contain costs and manage exposure.
  • Legal Exposures and Mitigation: Reviews and analyzes legal exposures. Collaborates with defense attorneys to manage legal issues. Proactively mitigates exposure to litigation, prices up claims for settlement, and works within authority to resolve claims.
  • Caseload Review and Management: Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure.
Requirements
  • Excellent Communication and Customer Service Skills: Demonstrated knowledge of workers' compensation laws and ability to adhere to statutes, regulations, and company policies and practices, as well as related claim management procedures/protocols.
  • Claims Adjusting or Insurance Experience: Two to five years of claims adjusting or insurance experience.
  • Self-Motivation and Analytical Skills: Self-motivated with excellent analytical, problem-solving, and decision-making skills. Strong ability to multi-task and prioritize.
  • Education and Certification: Must have a High School Diploma or GED equivalent. If state certification or license is required, must meet requirements and obtain certification within state-mandated timeframe and maintain any required license through continuing education.
Preferred Qualifications
  • Bachelor's Degree or Equivalent Business Experience: Preferred but not required.
  • Insurance Certification: WCCP, AIC, ARM, CPCU, or other insurance certification a plus.
Work Environment
  • Remote Work Opportunity: This role is remote, and only open to candidates currently located in the United States and able to work without sponsorship.
  • Work Hours and Travel: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. May be required to travel to off-site locations to attend meetings, as necessary.

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