Claims Associate - Consumer

Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency. May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.

Title: Claims Adjuster - Workers Compensation
Location: West Des Moines, Iowa REMOTE
Duration: 2+ Months

Description:
Work Location (Remote, Hybrid, or On-site): would prefer onsite but will look at hybrid/remote due to urgent need/ Expected Duration: 1- 3 months
Shift and Schedule Details: 8-4:30 CST M-F (some flexibility on start/end time)
Required Skills, Certifications, and Experience: Valid adjuster license
Preferred ("Nice-to-Have") Skills, Certifications, and Experience: licenses in MN, AR, TX, IL


Process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.

Job Description

PRIMARY PURPOSE: To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.


ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
Administers subrogation of claims and negotiates settlements.
Communicates claim action with claimant and client.
Ensures claim files are properly documented and claims coding is correct.
May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
Maintains professional client relationships.

Skills:
Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations
Education:
Bachelor's degree from an accredited college or university preferred.