East Coast Risk Management (ECRM) is looking for a dynamic worker compensation claims adjuster. This position is available for immediate placement and will be servicing clients based in West Virginia and Pennsylvania.
The Claims Adjuster is responsible for: analyzing complex or technically difficult claims to determine benefits due; working with high exposure claims involving litigation and rehabilitation; ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and identifying subrogation of claims and negotiating settlements.
Specific tasks/responsibilities of the Adjuster include but are not limited to:
- Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Assesses liability and resolves claims within evaluation.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
- Prepares necessary state fillings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Coordinates vendor referrals for additional investigation and/or litigation management.
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
- Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
Qualified candidates for the Workers Compensation position must have the following credentials:
- In-depth knowledge of workers compensation claims and associated legal concepts and principles
- Extensive experience adjusting West Virginia and Pennsylvania claims.
- Strong understanding of medical terminology.
- Knowledge of computer software products such as Word, Excel, Outlook and the ability to learn and use web-based claims systems.
- Strong written and verbal communication skills.
- Proven client relationship capabilities.
- Ability to negotiate settlements and work with legal counsel.
- Working understanding of medical bill coding.
- Ability to think critically, solve problems, plan and organize activities.
- Analytical skills necessary to make decisions and resolve complex issues inherent in handling claims.
Qualified candidates for the Workers Compensation position must have the following experience and education:
- High School Diploma
- Three to five years of claims adjusting experience
- Appropriately licensed and/or certified in all states in which claims are being handled.
ECRM offers competitive pay and a comprehensive benefit package. ECRM is an Equal Opportunity Employer.