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EMPLOYERS · 1 day ago

Claims Adjuster I | Southern States

United States

Full-time

Remote

Entry Level

$48K/yr - $65K/yr

1+ years exp

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.

FinanceFinancial ServicesInsurance

No H1B

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

Qualification

Workers' compensation experienceLawsRegulationsAnalytical skillsInsurance certificationsProblem solving skillsDecision-making skillsCustomer service skillsMulti-taskingPrioritizationCommunication skillsSelf-motivated