Claims Adjuster
3 weeks ago
Job Summary:
Elite Services is seeking a highly skilled Claims Adjuster - Loss Control Specialist to manage all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.
Key Responsibilities:
- Effectively manage a caseload of 110 to 160 workers' compensation files, including very complex claims.
- Initiate and conduct investigations in a timely manner.
- Determine compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
- Manage medical treatment and medical billing, authorizing as appropriate.
- Communicate with claimants, providers, and vendors regarding claims issues.
- Compute and set reserves within Company guidelines.
- Maintain a diary system for case review and document files to reflect the status and work being performed.
- Communicate information promptly to clients to resolve claims efficiently.
Requirements:
- High School Diploma or GED required.
- Bachelor's degree in a related field (preferred).
- Five (5) or more years of related experience.
- Texas Workers Compensation License.
Preferred Qualifications:
- Technical knowledge of statutory regulations and medical terminology.
- Analytical skills.
- Excellent written and verbal communication skills.
- Ability to interact with persons at all levels in the business environment.
- Proficient in Word and Excel.
About Elite Services:
Elite Services is a leading provider of workers' compensation claims management services. We are committed to delivering exceptional results and building long-term relationships with our clients.
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