Workers Compensation Claims Adjuster Job Description
Workers compensation claims adjuster
provides extensive case management and coordinates administrative aspects of the cases and claims in accordance with applicable insurance policies, local, State and Federal regulations.
Workers Compensation Claims Adjuster Duties & Responsibilities
To write an effective workers compensation claims adjuster job description, begin by listing detailed duties, responsibilities and expectations. We have included workers compensation claims adjuster job description templates that you can modify and use.
Sample responsibilities for this position include:
Handle claims consistent with clients' and corporate policies, procedures and standard methodologies and also in accordance with any statutory, regulatory and ethics requirements
Plan, recommend, reserve and execute file strategies on assigned claims in a manner consistent with corporate claim policies and procedures
Conduct a thorough analysis of the claim
Ensures the accurate, timely, and appropriate delivery of workers’ compensation benefits in accordance with California laws
Assures and directs appropriate medical care and litigation management
Assures accurate and timely maintenance of reserving and excess reporting
Assures timely and thorough completion of diaries and file documentation
Supports THPM initiatives as assigned
Determines necessity and manages independent adjusters and investigators
Recognizes, analyzes and provides documentation of trends
Workers Compensation Claims Adjuster Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Workers Compensation Claims Adjuster
List any licenses or certifications required by the position: ARM, AIC, CPCU
Education for Workers Compensation Claims Adjuster
Typically a job would require a certain level of education.
Employers hiring for the workers compensation claims adjuster job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Education, Business, Technical, Management, Public Administration, Industrial, Industrial Engineering, Business/Management, Business/Administration, Continuing Education
Skills for Workers Compensation Claims Adjuster
Desired skills for workers compensation claims adjuster include:
Claim file process through presentation of actions and responses to client questions
Accepted industry standards and practices Computer experience with related claims and business software
Accepted industry standards and practices
State laws and regulations pertaining to the insurance industry
Microsoft Office Applications and ability to learn new software programs
Insurance theory and practices
Insurance contracts and their application
Claim procedures
Policies
State and federal laws and insurance regulations
Desired experience for workers compensation claims adjuster includes:
NY Workers' Compensation expereince and license is preferred
2 years’ experience in job-related functions or equivalent • Insurance coursework
NH,MA and VT expereince and license is preferred
Must have VT, NH and MA experience
Review, process and handle worker's compensation claims
Under technical direction, works within significant limits and authority to actively manage a caseload of complex lost time cases in the California jurisdiction
Workers Compensation Claims Adjuster Examples
1
Workers Compensation Claims Adjuster Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of workers compensation claims adjuster. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for workers compensation claims adjuster
- Reviewing and analyzing medical bills to confirm charges and treatment are workers’ comp injury-related and in accordance with the treatment plan
- Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statute
- Answer questions regarding the status of pending claims from claimants, policyholders and medical providers
- Consult with attorneys regarding litigation management, settlement strategy and claim resolution
- Under technical direction, works within significant limits and authority to actively manage a caseload of complex lost time cases in the Nevada jurisdiction
- Review, process and conclude lower severity claims as trained and directed
- Completes quality investigation by gathering all pertinent information
- Makes prompt contact with policyholders, claimants, medical providers, and other parties involved in the loss to set expectations, develop an action plan and perform an initial exposure assessment
- Conducts investigation to determine coverage, liability, and damages, including recorded statements
- Review, process and conclude moderate severity California State and Federal claims that may be limited in exposure but occasionally complex in nature
Qualifications for workers compensation claims adjuster
- Minimum of three years of successful workers’ compensation claim management experience adjudicating claims in the California jurisdiction
- Proficient jurisdictional knowledge of workers’ compensation law and ability to adjudicate claims in the California jurisdiction upon date of hire
- Bachelor's degree from an accredited college of university
- Must possess a high level of negotiation skills and be able to effectively handle conflict and emotional issues that arise in the arena of workers compensation claims
- 5-7 years experience as a Workers Comp adjuster
- MS Office experience (Work, Excel, Outlook)
2
Workers Compensation Claims Adjuster Job Description
Job Description Example
Our company is growing rapidly and is looking for a workers compensation claims adjuster. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for workers compensation claims adjuster
- Monitors provider compliance to the MCO contract, the workers’ compensation medical and MCO rules, and the MCO treatment guidelines
- Coordinates the Dispute Resolution Program involving payers, employers, physicians, and workers
- Provides all new client orientations and training
- Acts as customer service resource for assigned clients, injured workers or their representatives, interested parties and participating providers
- Provides effective medical and administrative problem solving and negotiation for program operations, dispute resolution, and medical treatment reviews
- At least seven years prior experience adjudicating complex lost time claims involving medical, legal and vocational rehabilitation issues
- The ability to mentor and train entry level claims professionals in the above jurisdictions is required
- Natural curiosity is key
- Being able to communicate with empathy is crucial
- You will need good conflict resolution skills to help the other party understand the position that has been presented
Qualifications for workers compensation claims adjuster
- Proficient jurisdictional knowledge of workers’ compensation law and ability to adjudicate claims in the Nevada jurisdiction upon date of hire
- Ability to multi-task and handle large volumes of work
- Must have Workers Compensation experience
- Must have Massachusetts Workers Compensation claims handling experience
- Industry designation such as AIC, CPCU preferred
- Professional oral and written communication skills are critical to the success of this position
3
Workers Compensation Claims Adjuster Job Description
Job Description Example
Our company is growing rapidly and is hiring for a workers compensation claims adjuster. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for workers compensation claims adjuster
- Being able to communicate fluently in English, both verbally and in writing is essential
- Being able to communicate fluently in Spanish as well, both verbally and in writing, is a significant plus, but not required
- Utilize active listening and critical thinking skills to quickly analyze and clearly understand a specific request or customer need and then leverage knowledge and resources to provide appropriate solutions
- Review, process and conclude lost time workers compensation claims or those limited in exposure but occasionally complex in nature
- Organize and work with detailed office or warehouse records, using computer to enter, access, search and retrieve data
- Review claims to determine whether or not claimant is covered under a policy, review policy to determine coverage, and evaluate the extent of a settlement
- Independently able to comply with carrier reporting requirements
- Conducts interviews with injured customers, store personnel and witnesses within twenty-four hours of receiving reported incident
- Coordinate with doctor, injured employee and store personnel light duty return to work and monitor on a weekly basis
- Maintain and monitor medical care to ensure appropriateness of treatment
Qualifications for workers compensation claims adjuster
- Must have New York Workers' Compensation Lost Time claims handling experience
- Must be able to collaborate and develop strong team relationships with associates from within and outside the Claims Department
- 1+ years’ experience and working knowledge of Florida Medical Only workers’ compensation claims Excellent verbal and written communication/customer service skills
- 3-5 years’ handling all aspects of workers’ compensation claims including litigated claims, with a consistent high level of performance and achievement
- Experience working with Public Entity accounts and knowledge of Heart & Lung (Presumption) claims a plus
- Proficient abilities to effectively operate a personal computer and related claims and business software, including EDI reporting
4
Workers Compensation Claims Adjuster Job Description
Job Description Example
Our company is hiring for a workers compensation claims adjuster. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for workers compensation claims adjuster
- Adhere to all department claim policy and procedures as set out in the procedure manual
- Controls activities of service providers such as defense attorneys, medical case managers and private investigators to minimize claim expense and maximize results
- Develops and maintains a proactive strategic plan of action for the life of the file
- Maintains a working knowledge of general liability laws and statutes for multiple states
- Handle a high volume of Workers’ Compensation claims, with a focus on financial accuracy, appropriate file disposition, and an adherence to statutory guidelines
- Foster a network of resources that may include doctors, nurses, attorneys, internal & external customers, and regulators to help achieve our mission of restoring lives
- Ability to make decisions with the customer at the center of everything we do
- Utilize critical thinking skills to gather and analyze information and data to make sound decisions
- Continually evaluate self against performance targets and strive to exceed expectations
- Contribute to a courageous culture that promotes collaboration and inclusion to maximize operational performance and employee engagement
Qualifications for workers compensation claims adjuster
- Ability to properly document all actions and work effectively in an electronic environment, utilizing a diary system properly and effectively
- Must have good judgment and handle confidential matters with integrity
- Ability to successfully negotiate settlements/close files, and handle EDI effectively
- Willing to travel for mediations, staff meetings, client visits, , as necessary
- Juris Doctor and 5 or more years of experience in the Workers Compensation Claims or Litigation area
- Experience handling OH, PA, NC and SC Workers Compensation Claims
5
Workers Compensation Claims Adjuster Job Description
Job Description Example
Our innovative and growing company is hiring for a workers compensation claims adjuster. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for workers compensation claims adjuster
- Review, process and conclude lower severity claims as trained and directed
- Horoughly investigating workers’ compensation claims by contacting injured workers, medical providers, and employer representatives
- Thoroughly investigating workers’ compensation claims by contacting injured workers, medical providers, and employer representatives
- Directly handing the most complex of Workers Compensation claims located with the region
- Investigate coverage and compensability on large/complex claims
- Timely establish reserves on large complex claims
- Report out to senior leadership and business partners
- Aggressively pursue resolution opportunities on complex claims
- Build relationships with business partners to ensure cost containment and effective claim handing
- Properly utilize and document all files in the claim system of record
Qualifications for workers compensation claims adjuster
- College Degree or combination of college courses and relevant work experience
- State of Oregon Claims Adjusting Certificate Required
- 2+ years’ experience with computer software applications
- 2+ years claims adjusting experience in workers’ compensation field
- Must demonstrate competency in medical terminology and medical claims management
- Ability to give effective group presentations and product training to clients and providers