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New Mexico Mutual · 1 day ago

Claims Adjuster Professional Trainee

Albuquerque,NM,US

Full-time

Onsite

New Grad

0+ years exp

New Mexico Mutual is a company focused on providing workers' compensation claims services. They are seeking a Claims Adjuster Professional Trainee to undergo a comprehensive training program and manage the adjudication of assigned claims under supervision.

Financial ServicesInsuranceService Industry

Responsibilities

This claim training will cover claim investigation, compensability, policy coverage, statutory law, case law, benefits analysis and payment, litigation, medical and claims resolution

Responsibilities include effective and consistent partnership with the employer, injured worker and medical provider, administration of benefits, litigation management and claims resolution

Verify claim information including but not limited to: documentation of the claim history; taking recorded statements from workers and witnesses, coordination of medical care

Document all activities in the claim management system

Responsible for outside legal counsel assignments, RTW strategies & all other expert assignments

Upon determination of compensability: Set and monitor reserves according to company policies and the worker’s injury, issue benefit checks in accordance to statutory requirements, and demonstrate proficiency in the application of state statutes, related case law and to interpret and comply with company claims standards, policies and procedures

Make required filings and ensure benefit payments within the established time frames and guidelines

Prepare, attend, and present a majority of all mediations and hearings

Represent the company at trial

Maintain a diary on all open claims

Document all relevant information to provide a clear history of events and a proper audit trail

Set review dates based on claim complexity or standard review criteria

Perform other duties as assigned

Qualification

Claims investigationPolicy coverageStatutory lawMS OfficeEffective communicationCollaborative skills

Required

Bachelor's Degree from an accredited college or university

No prior claims handling experience is necessary for this position

MS Office (Word, Advanced Excel, PowerPoint, Outlook)

Adheres to New Mexico Mutual's values and mission by demonstrating Service Excellence, Trust, Ownership, One Team and Boldness in thought and action

Develops and maintains positive working relationships with team members, customers, co-workers, and management by demonstrating effective communication and collaborative skills