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Builders · 1 month ago

Senior Workers Compensation Claims Adjuster

United States

Full-time

Remote

Senior Level

5+ years exp

Builders is a mid-sized mutual insurance company known for its strong financial strength and customer-centric culture. The Senior Workers Compensation Claims Adjuster is responsible for managing a caseload of claims, ensuring compliance with industry regulations, and providing exceptional customer service throughout the claims process.

Financial ServicesInsurance

Responsibilities

Manage a caseload of limited coverage and medium to severe claims with authorization to resolve cases within a designated monetary threshold. Develop and implement impactful strategies to negotiate and resolve claims within established parameters. Strive to achieve fair and equitable outcomes while steadfastly upholding company and departmental protocols and standards

Deliver quality customer service to all parties involved in the claim process, ensuring prompt and efficient delivery of appropriate benefits. Actively participate in meetings or visits with agents, insurers, and policyholders to cultivate professional relationships and facilitate effective issue resolution

Conduct investigations into losses utilizing various techniques such as interviews, recorded statements, and thorough documentation. Diligently gather and preserve evidence

Identify opportunities for subrogation or instances of potential fraud. Verify, analyze, and apply coverage correctly to each case based on a thorough analysis of facts and pertinent statutory case law. Scrutinize bills, determine necessary actions, and process claims accordingly, prioritizing cost-effective resolutions

Prepare concise and timely reports to facilitate efficient claims processing. Keep agents, insurers, agency operations, and the corporate Claims Department informed of file status and pertinent developments. Ensure accurate and timely filing of all state forms required for claims processing; prepare necessary reports for large loss and reinsurance carriers

Establish reserves and authorize payments in alignment with established procedures

Scrutinize contracts to evaluate risk transfer and assess duty to defend and indemnify additional insured parties

Manage the litigation process in an efficient and effective manner. Determine the necessity for, and provide guidance to defense counsel, independent adjusters, or technical experts, while monitoring and managing their expenses. Attend hearings, pre-trial settlements, conferences and trials

Assess the need for independent medical evaluations, second opinions, nurse or physician reviews, and make referrals. Evaluate the need for external services such as surveillance, field adjusters, or field case managers or coordinating referrals

Maintain detailed documentation of claims activity in claim notes, regularly reviewing and updating diaries and claim notes for all open claims

Meet or exceed expected quality performance guidelines to uphold service standards

Participate in professional development through training programs to stay updated on workers’ compensation laws, rules, and regulations

Identify cases necessitating large loss and/or reinsurance reports, ensuring comprehensive management

Conduct thorough file reviews at various stages of the claims process

Contribute to the training of workers’ compensation claim staff under the guidance of management

Serve as a technical expert and offer support to management

Monitor litigated files to ensure adherence to litigation management protocols

Utilize Insurance Service Office (ISO) decision net and claim search inquiries

Respond to complaint calls and other inquiries, excluding those related to Department of Insurance (DOI) complaints, with professionalism and efficiency

Performs other duties as assigned

Qualification

Workers' compensation experienceClaims processingLicensed in multiple jurisdictionsState lawsClaims policy knowledgeMicrosoft Office SuiteCustomer servicePlanningOrganizationInterpersonal skillsProblem-solvingTime managementConflict resolutionVerbal communicationWritten communicationAttention to detail

Required

Bachelor's degree or equivalent combination of education and/or experience in the insurance field

Five or more years of workers' compensation experience including complex case processing

Licensed in multiple jurisdictions with a professional claims designation

Knowledge of applicable state laws across territories of operation

Knowledge of claims policy, procedures, fiduciary guidelines and best practices

Skill in interpersonal interactions, with the ability to collaborate effectively with individuals at all organizational levels and with external stakeholders; skill in customer service, problem-solving time management and conflict resolution

Capacity to work autonomously while ensuring transparent communication with internal leadership

Skill in planning, time and organizational management; ability to multi-task effectively while paying attention to detail

Proficient in both verbal and written communication with the ability and commitment to maintain confidentiality

Proficient with Microsoft Office Suite and function specific software applications

Benefits

Competitive Salary

Bonus Structure

Profit Sharing

Medical, Dental, Vision Insurance

Employer Paid Short Term Disability

Employer Paid Long Term Disability

Employer Paid Life Insurance

Voluntary Life Insurance

401K with Company Match

PTO

Company

Builders

Great Place To Work Certified™ | Best Places To Work in Insurance 2024 | Rated A “Excellent” by AM Best | 32+ years strong | Competitive salaries and benefits | Expertise and Compassion INSURANCE BUILT STRONG® We bring peace of mind to businesses, safeguard workers and their families, and invest purposefully back into our communities and team members.

Founded in 1992

Atlanta, Georgia, USA

201-500 employees