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Experienced Workers' Compensation Claims Adjuster
2 months ago
The ideal candidate will possess a comprehensive understanding of Workers' Compensation and demonstrate a commitment to expanding their knowledge across various jurisdictions. A valid New York Adjuster's license is essential.
Applicants must hold a valid license for their state of residence if required, with additional licenses in other jurisdictions being advantageous. The role involves managing claims across multiple states, necessitating a willingness to learn and adapt.
Candidates should have 3 to 5 years of relevant experience in handling Workers' Compensation claims. Eligibility for reserve/payment authority of $50,000 or more is required, along with the necessary Adjuster's licenses and the ability to secure any additional jurisdictional licenses post-hire.
The selected individual will manage a caseload of approximately 150 claims, varying in complexity. Responsibilities include determining facts of loss, conducting coverage analysis, investigating claims, assessing compensability, managing litigation, evaluating damages, negotiating settlements, and identifying potential fraud. Timely reserve analysis and report completion are also critical. The role may involve attending conferences, client meetings, mentoring junior adjusters, and supporting management as needed. All file handling must comply with state regulations, client guidelines, and best practices.
Key Responsibilities:
- Coverage Assessment: Analyze and confirm coverage details.
- Client Interaction: Communicate with relevant parties to ascertain liability and compensability.
- Maintain regular contact throughout the claims process.
- Provide training and mentorship to junior Claims Adjusters.
- Assist management with various projects as required.
- Handle responsibilities of the Assistant Unit Manager/Unit Manager in their absence.
- Participate in meetings via virtual platforms as necessary.
- Subrogation: Refer cases with subrogation potential to the appropriate department.
- Investigation: Verify facts of loss and gather necessary claims information.
- Identify and evaluate cases for settlement, ensuring timely negotiation.
- Recognize and report potential fraud cases.
- Litigation Management: Develop litigation strategies with defense counsel, ensuring timely completion of necessary filings.
- Review litigated claims regularly and document all relevant actions.
- Attend mediations and trials as required.
- Reserve Management: Establish and monitor reserves based on anticipated costs.
- Ensure timely payment of benefits and review provider bills.
- Reporting: Report significant injuries and potential large loss claims to clients.
- Adhere to internal and external audit requirements.
- Claims Resolution: Document action plans and maintain regular monitoring of claims.
- Close files in a timely and efficient manner.
Qualifications:
- High School Diploma required; college degree preferred.
- 7 to 10 years of claims experience, ideally in the relevant field.
- 7+ years of heavy litigation experience for lines other than Workers' Compensation.
- 5+ years of experience in Construction Defect or related fields if applicable.
- Eligibility for reserve/payment authority of $50,000 or more.
- Possession or ability to obtain a Florida Adjuster's license or other necessary licenses.
- Technical Skills: Strong interpersonal skills for handling sensitive information, advanced negotiation abilities, and proficiency in Microsoft Office applications.
- Physical Requirements: Ability to sit for extended periods, lift files up to 20 pounds, and travel as needed.
North American Risk Services (NARS) is a leading third-party claims administrator committed to delivering optimal results for our clients. Established in 1996, we manage claims for a diverse range of clients, including insurers, brokerages, and self-insured entities.
