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SAIF Corporation · 1 week ago

Bilingual Claims Adjuster Trainee

United States

Full-time

Remote

New Grad

$69K/yr - $81K/yr

SAIF Corporation is Oregon’s leading workers’ compensation insurer, dedicated to making the state a safer place to work. They are seeking a Bilingual Claims Adjuster Trainee who will enter a paid training program to gain the necessary skills for managing claims and assisting injured workers throughout the claims process.

AssociationFinancial ServicesNon Profit

Comp. & Benefits

Responsibilities

Attend and acquire knowledge through a formal training program consisting of classroom training and on-the-job training (OJT) experiences to obtain the basic skills and knowledge needed to provide claims management services. Training will provide information concerning laws, regulations, administrative rules, corporate policies and procedures and claims management systems that affect the processing of workers’ compensation claims

Participate in OJT experiences in both compensability and disabling claims functions to apply knowledge to actual case situations. Participate in on-going training opportunities to develop skills in all aspects of claims management, benefits/benefits entitlement, and customer service

Develop skills in evaluating claims information to determine compensability, benefit entitlements, claim reserves, and settlement parameters based on claims analysis

Review assigned claims; develops, initiates, and follows through on plans of action. Investigates and obtains medical reports and other information required to make appropriate benefit decisions and manage claims. Ensures timely processing of claim documents based on state regulatory guidelines

Analyze claim information, establish reserves up to a $10,000 authority limit for the ultimate probable cost, and document justification. Refer claims exceeding personal reserving authority to supervisor or designee for approval. Communicate reserve decisions to all interested parties. Re-evaluate and adjust reserves as claim exposure changes

Establish settlement value and settle within authority from supervisor or director. Negotiate settlements with unrepresented injured workers or legal counsel

Authorize and ensure timely and accurate payment of benefits based on applicable statute and administrative rules

Maintain claim records and prepare claim documentation per corporate policies and standards to ensure full compliance with workers' compensation laws and rules

Collaborate with interested parties as needed to coordinate claims management activities and claim resolution

Visit and consult with policyholders and agents to discuss claims status and action plans

Mitigate claims costs by referring claims with a potential for specialized cost containment services to business partners

Manage claims issues until the claims are no longer active. Take action to resolve claims through closure or settlement and/or effects changes in benefit entitlement. Expedites resolution of litigation where possible

Comply with the initial examiner certification requirement of successfully passing the final examination and continuing education requirements in accordance with the Oregon Administrative Rules (OARs), Chapter 436, Division 55, to ensure continued certification as a workers' compensation claims examiner

Explore diverse perspectives and consistently behave sensitively toward differences in cultural norms, expectations, and ways of communicating. Work effectively with others who have different perspectives, backgrounds, and/or work styles

Continually sustain the Inclusive Leadership Competencies (ILC) through the Explorer level on an annual basis