Claims Adjuster - Workers Compensation
Location: Albuquerque, New Mexico
Description: QuestPro Consultants - TN is looking of Claims Adjuster - Workers Compensation right now, this career will be dwelled in New Mexico. For detail informations about this career opportunity kindly read the description below. Workers Compensation Adjuster
Mono-Line carrier, an industry leader in Workers Compensation, is seeking several qualified claims experts to fill all l! evels of WC Claims Adjuster roles. The client is located in Albuquerque, NM and is actively looking to relocate qualified candidates.
Company believes that its greatest asset is its employees and works very diligently to create a positive work environment and culture where employees are challenged and feel valued. Client offers employees a comprehensive benefit package with work/life balance as well as an outstanding opportunity to grow careers as well.
This position is responsible for the handling of all assigned claims in accordance with the Act, governing rules and regulations, related case law and company procedures. Case complexity assignment is determined by the experience and qualifications of the adjuster.
Essential Functions:
• Contact the injured worker, employer and medical provider as allowed by law to investigate, determine compensability and pay benefits.
• Documents all activities in the claim system, maintains t! he claim file. Verifies claim history and facts, takes recorde! d statements, and coordinates clinical information with Medical Case Managers.
• Contact injured worker, employer and all other necessary parties to gather the information necessary to determine coverage, compensability and benefits.
• Provide positive service and communication with the worker and employer to develop the best possible working relationship. Identify and resolve any area of concern.
• Verify claim information including but not limited to: documentation of the claim history; taking recorded statements from workers and witnesses and coordination of clinical information with the Medical Case Manager.
• Upon determination of compensability: Set and monitor reserves according to company policies and the workers’ injury, issue benefit checks in accordance to statutory requirements, prepare case management and closure strategy with the Medical Case Manager.
• Demonstrated ability in the knowledge of app! licable state statutes, related case law and to interpret and comply with company claims standards, policies and procedures.
• Provide concise, comprehensive written or verbal communication to all relevant parties.
• Make required filings and assure benefit payments within the established time frames and guidelines.
• Prepare, attend and present a majority of all mediations and hearings. Represent the company at trial.
• Set, monitor and adjust reserves according to company procedures and the workers’ injury.
• Identify, investigate and subrogation potential.
• Make referral for legal representation according to company procedure.
• Determine case values and make settlement recommendations on claims above individual authority
• Negotiate settlements with workers, their attorneys and third parties within individual authority and authority granted by a manager or the Director.
• Maintain a d! iary on all open claims. Document all relevant information to provide a! clear history of events and a proper audit trail. Set review dates based on claim complexity or standard review criteria.
Other Functions:
• May be required to communicate with injured workers, obtaining recorded statements. Assist other staff members within the company with Spanish speaking individuals as needed.
• Directs, manages, and monitors legal counsel on assigned litigated files. Directs case managers on assigned files.
• Performs other duties as assigned by the Claims Supervisor, Manager or Director.
Job Qualifications
Education:
Bachelor’s Degree from an accredited college or university; and three to six years of directly related experience and/or formal training; or six to eight years experience in directly related field, or the equivalent combination of education and experience. Related education and/or professional certifications preferred.
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If you were eligible to th! is career, please send us your resume, with salary requirements and a resume to QuestPro Consultants - TN.
Interested on this career, just click on the Apply button, you will be redirected to the official website
This career will be opened on: Thu, 21 Nov 2013 09:37:01 GMT
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