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EMPLOYERS · 19 hours ago

Claims Adjuster II | Nevada

United States

Full-time

Remote

Entry, Mid Level

$50K/yr - $75K/yr

2+ years exp

EMPLOYERS is a dynamic provider of workers' compensation insurance and services, seeking a Claims Adjuster II to manage workers’ compensation claims. The role involves timely and accurate claim management, customer service, and collaboration with legal teams to mitigate exposure to litigation.

FinanceFinancial ServicesInsurance

No H1B

Responsibilities

Completes initial contacts to obtain necessary additional information, verify coverage, determine compensability and develop of plan of action. Completes and maintains accurate claim system data as it pertains to work comp insurance claims

Analyzes case facts to establish timely and accurate case reserves using knowledge of medical disabilities and related costs, as well as judgment of 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 procedures and guidelines. Files appropriate state forms, as needed

Proactively coordinates and monitors medical treatment to continue to move the claim forward. Uses resources, internal and external, to contain costs and manage exposure

Reviews and analyzes legal exposures. Collaborates with defense attorneys to manage legal issues. Proactively mitigates exposure to litigation, prices up claims for settlement and works within authority to resolve claims

Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure

Other duties as assigned

Qualification

NV Staff Adjuster LicenseWorkers’ Compensation lawsClaims adjusting experienceAnalytical skillsCustomer service skillsMulti-taskingProactive medical managementCommunication skillsProblem solving skillsDecision-making skillsNegotiation skills

Required

Currently hold a NV Staff Adjuster License

2 - 5 years' work comp claims adjusting or insurance experience

3 years experience managing NV claims at a high level (compensability and claim reopening investigation skills, accurate benefit calculation and delivery, accurate claim reserving, proactive medical management, litigation avoidance and negotiation skills)

Ability and willingness to manage additional jurisdictions such LA and TX

Excellent communication and customer service skills and knowledge of 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 excellent analytical, problem solving and decision-making skills

Strong ability to multi-task and prioritize

High school diploma or equivalent required

Equivalent combinations of education and experience may be considered