Workers Compensation Claims Adjuster II
4 weeks ago
Job Type: Temporary
Job Summary:As a Claims Adjuster II - Temp Workers Compensation Specialist, you will be responsible for managing an assigned inventory of claim files to conclusion. This role requires a strong understanding of workers compensation claims and the ability to effectively communicate with claimants, employers, and medical professionals.
Key Responsibilities:- Perform a three-point contact on all new losses within 24 hours to document relevant facts and gather evidence.
- Thoroughly gather evidence and information necessary for establishing compensability and resolving claims.
- Develop and maintain up-to-date plans of action for assigned indemnity claims.
- Partner with medical case managers to maximize early return to work potential and reduce disability payments.
- Initiate referrals to the Special Investigations Unit (SIU) for cases with suspected fraud.
- Pursue subrogation from culpable third parties and contributions on multiple defendant cases.
- Ensure claim files are handled in accordance with applicable statutes and company guidelines.
- Review and approve vocational rehabilitation plans.
- Establish and adjust monetary case reserves as needed.
- Review medical bills for appropriateness prior to referral for payment.
- Exhibit a courteous and professional attitude and maintain a high level of customer service.
- Problem Solving: Identify and resolve problems in a timely manner.
- Customer Service: Manage difficult customer situations and respond promptly to customer needs.
- Interpersonal: Focus on solving conflict and maintain confidentiality.
- Team Work: Support everyone's efforts to succeed.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Bachelor's degree (B.A.) or equivalent from four-year college or; or 3-5 years related experience & training, 5 years without a SIP certificate, or equivalent combination of education and experience.
Intercare Holdings Insurance Services, Inc.
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