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EMPLOYERS · 1 day ago

Senior Work Comp Claims Adjuster II | Nevada & Texas

United States

Full-time

Remote

Senior Level

$70K/yr - $100K/yr

7+ years exp

EMPLOYERS is a dynamic, fast-growing provider of workers' compensation insurance and services, seeking a goal-oriented individual. The Senior Work Comp Claims Adjuster II is responsible for timely and accurate management of complex workers’ compensation claims, collaborating with various stakeholders to ensure effective resolution and customer service.

FinanceFinancial ServicesInsurance

No H1B

Responsibilities

Completes initial contacts to obtain necessary information, verify coverage, determine compensability and develop a plan of action as it pertains to work comp claims

Completes and maintains workers' compensation claim data integrity

Independently analyzes case facts to establish timely and accurate reserves using knowledge and experience with medical disabilities and related costs, as well as judgment of extent of disability

Collaborates with Corporate Claims to proactively evaluate and mitigate high exposure, serious or catastrophic workers' compensation losses

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 procedures and guidelines

Files appropriate state forms, as needed

Proactively manages or coordinates medical treatment to continue to move the claim forward

Uses internal and external resources to contain costs and manage exposure

Reviews and analyzes litigation and legal issues. Directs legal strategy and participates in preparation of the case for litigation

Collaborates with defense attorney to move claims to resolution

Completes detailed settlement analysis and recommends appropriate settlement value, utilizing in-depth knowledge of appropriate workers’ compensation insurance principles and laws, subrogation recoveries, offsets and deductions, claim and disability duration, cost containment principles; including medical management practices and Social Security and Medicare application procedure as applicable

Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure. Uses a high degree of independent judgment to render accurate decisions

Mentors other team members and acts as a Subject Matter Expert for legal, jurisdiction and Company needs. May handle supervisory duties, as needed

Qualification

Workers' compensation claimsComplex claims handlingWorkers' compensation lawsAnalytical skillsCustomer service skillsMulti-taskingPrioritizationInsurance designationsCommunication skillsProblem solvingDecision-making skillsSelf-motivatedMentoring

Required

7+ years of experience adjusting NEVADA work comp claims

10 or more years of workers' compensation insurance claims experience including complex claims handling

Superior communication and customer service skills and proficiency in an imaged environment

Demonstrated knowledge of workers' compensation laws and ability to adhere to statutes, regulations and company policies and practices, as well as related claim management procedures/protocols

Self-motivated with the ability to work independently with minimal direction

The ability to multi-task and prioritize, adhere to deadlines and complete assignments accordingly

Excellent analytical, problem solving and decision-making skills