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Work Comp Claims Adjuster (VT, ME & CT, MA, NH, RI) job in Philadelphia at Elite

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Work Comp Claims Adjuster (VT, ME & CT, MA, NH, RI) at Elite

Work Comp Claims Adjuster (VT, ME & CT, MA, NH, RI)

Elite Philadelphia, PA (On Site) Full-Time
POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

DUTIES AND RESPONSIBILITIES:
  • Adjuster can work remotely from home
  • Effectively manages a caseload of 125 to 175 workers' compensation files, including very complex claims.
  • Jurisdictions are New England - CT, MA, ME, NH, RI and VT
  • Initiates and conducts investigation in a timely manner.
  • Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
  • Manages medical treatment and medical billing, authorizing as appropriate.
  • Refers cases to outside defense counsel. Directs and manages as appropriate.
  • Communicates with claimants, providers and vendors regarding claims issues.
  • Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.
  • Settles and/or finalize all claims and obtains authority as designated.
  • Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
  • Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
  • Adheres to all Company policies and procedures.
  • Conducts file reviews independently.
  • Other duties as assigned.
* Essential job function.

EQUIPMENT OPERATED/USED: Computer, fax machine, copier, printer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate business casual office attire

QUALIFICATIONS REQUIRED:

Education/Experience : High School Diploma or GED required; Bachelor's degree in related field (preferred); three (3) to five (5) or more years related experience; or equivalent combination of education and experience preferred.

Knowledge, Skills and Abilities :
  • Technical knowledge of statutory regulations and medical terminology.
  • Analytical skills.
  • Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
  • Ability to interact with persons at all levels in the business environment.
  • Ability to independently and effectively manage very complex claims.
  • Proficient in Word and Excel (preferred).

Other Qualifications :
  • Desired to have, but not required to have upon offer of employment, though if offered employment then the following states licenses would be obtained over a period of time established by the COMPANY; Connecticut, Maine, New Hampshire, Rhode Island and Vermont adjuster licenses

Recommended Skills

  • Analytical
  • Audio Equipments
  • Claim Processing
  • Communication
  • Fax
  • Medical Billing And Coding
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