[Remote] Claims Adjuster I | Southern States

Note: The job is a remote job and is open to candidates in USA. EMPLOYERS is a dynamic, fast-growing provider of workers' compensation insurance and services. They are seeking a Claims Adjuster I responsible for managing workers’ compensation claims with low to moderate medical and indemnity benefit exposure, ensuring timely and accurate claim processing while providing excellent customer service.

Responsibilities

• Receives and reviews new claims involving low to moderate medical, indemnity and occasional legal exposure. Caseload may include complex Medical Only claims
• Completes initial contacts to obtain necessary information, verify coverage, determine compensability and develop a plan of action. Completes and maintains accurate claim system data
• Analyzes case facts to establish timely reserves using and building knowledge of medical-related costs and judgment about extent of disability
• Provides timely and appropriate customer service within established best practices. Maintains ongoing professional communications with all internal and external customers
• Accurately evaluates and pays benefits in compliance with statutory and company guidelines. Files appropriate state forms, as needed
• Proactively coordinates or monitors medical treatment to continue to move the claim forward. Uses resources, internal and external, to contain costs and manage exposure
• Working with supervisor, reviews and analyzes some legal issues. In collaboration with defense attorneys, proactively handles and mitigates exposure to litigation and prices up claims for minor settlements
• Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure

Skills

• 1 to 2 years of workers' compensation claims experience
• Knowledge of workers' compensation laws, regulations and statutes
• Excellent communication and customer service skills and knowledge of an imaged environment
• Self-motivated with excellent analytical, problem solving and decision-making skills
• Strong ability to multi-task and prioritize
• Must meet certification within state-mandated timeframe and maintain any required license through continuing education
• Experience in FL, TN, MS, KY, AL, AR
• WCCP, AIC, ARM, CPCU or other insurance certification preferred
• Bachelor's degree or the above experience preferred

Benefits

• Comprehensive benefits package

Company Overview