Workers Compensation Claims Adjuster
East Coast Risk Management, LLC - West Lafayette, OH

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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.

Qualifications

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.

Experience

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.


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About this company
East Coast Risk Management LLC is a management consulting firm specializing in Risk Management, Workplace Safety , Workers' Compensation and...