Claims Adjuster
Employers - Brookfield, WI

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As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work!
We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS®!
Headquartered in Reno, Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees.

We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other!

At EMPLOYERS , you’ll discover an energetic environment that inspires top achievement. As “America’s small business insurance specialist”, we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career.

Summary:
Perform duties to manage a caseload of complex workers’ compensation claims, determine compensability, set reserves, and process payments, within the limits of standard or accepted practice. Analyzes and interprets statutes and regulations applying to case facts to render appropriate legal and ethical decisions. Analyzes legal issues, provides input on legal strategy and utilizes independent judgment in decision-making while managing claims in a prompt and thorough manner from inception through closure. Aggressively negotiates settlement of claims. Work will be performed under direct supervision within a computer-based environment. Continually increases technical knowledge.

Essential Functions:
1. Responsible for complex and difficult cases. Receive and review information related to new claims. Communicate with injured workers, employers, and medical providers. Conduct prompt and thorough investigation of case facts and circumstances. Interprets and applies appropriate statutes and regulations in determine compensability. Understands and adheres to Claims Best Practices.
2. Assigns case to contactor if applicable for investigation of circumstances when compensability is questionable.
3. Accurately calculates and pays appropriate benefits in a timely manner, proactively manages claim costs and expenses.
4. Set up file diaries, manage medical treatment, establish reserves up to authority level, submit reserve recommendations of higher level for authorization, and file required State forms. Document follow-up care, actions taken to settle claim and other claim related activity. Has authority to settle claims.
5. Independently analyzes case facts to establish timely and accurate case reserves. Requires knowledge of medical disabilities and related costs, as well as judgment of extent of disability. Applies knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost.
6. Review case facts to identify possible fraud or abuse throughout course of claim.
7. Follow up with contacts to medical provider and insured employer regarding injured workers’ progress. Ensures quality case and medical management by applying appropriate medical concepts, and by interpreting and applying appropriate statutes and regulations. Requires a high degree of independent judgment to apply facts of case and render accurate decisions. Support the process by scheduling medical or testing appointments and providing authorizations. Demonstrate sound medical management skills and aggressive claims handling, proactively pursuing return to work.
8. Using strong claims management skills monitors and adheres to a written plan of action to facilitate ongoing claim management, quick resolution and best possible outcome.
9. Proactively manages claims litigation process. Handles legal issues that can be adjudicated without the use of a defense attorney. Directs legal strategy and participates in preparation of case for next level(s) of litigation. Testifies at those levels as required.
10. Composes professional letters to insured’s, physicians and employees, as necessary.
11. Review and respond to incoming mail, emails, telephone calls and fax transmissions from providers and injured worker, related to caseload. Take actions required to respond within regulations and policy.
12. Review and approve or deny medical bills.
13. Audits physician reports of permanent partial disability evaluations to ensure accuracy in accordance with the specific jurisdictional guides. Ensures prompt and appropriate processing of permanents partial disability benefits.
14. Evaluates, prepares, and presents cases of possible permanent total disability to the appropriate jurisdiction department.
15. Evaluates and identifies third party liability.
16. Participates with Underwriting Department as needed in agent or insured’s claims staffing.
17. Assumes the duties of Co-Adjusters in their absence.
18. Provides testimony at hearings as needed.
19. Conduct business at all times with the highest standards of personal, professional and ethical conduct.
20. Ensures timely compliance with all policy and procedures as well as jurisdictional statutes.
21. Ensures timely and independent compliance with management issues; prioritizes and ensures timely completion of activities and assignments.
22. Established and maintains ongoing professional communications with all appropriate parties, internal and external, ensuring satisfaction with company services.
23. Mentors junior Claims Adjusters.
24. Maintains professional and technical knowledge by attending employer sponsored training classes.
25. Visits employers relative to claims management, as required.
26. All other duties as assigned or as situation dictates.

Required Minimum Qualifications / Knowledge, Skills & Abilities:
• Superior written and oral communication, listening, interpersonal, customer service and telephone skills
• Proficient in the use and knowledge of MS Office software, with the ability to type at a minimum of 35 wpm.
• 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, AMA Guides to the Evaluation of Permanent Impairment and medical terminology.
• Demonstrated skill in working independently with minimal direction, multi-tasking skills, determine the relative importance of each, adhere to deadlines, and complete assignments accordingly.
• Excellent analytical, problem solving and decision-making skills and ability to deal professionally with people in stressful situations.
• Ability to maintain confidentiality.
• If State Certification is required, must meet certification within state mandated time frame.
• Must have High School Diploma or GED equivalent.
• Minimum of 3-5 years experience working in a claims environment at the Adjuster level or higher managing exposure lost time claims of a complex nature.
• Ability to participate in job related internal and external training and pass any tests within the set guidelines.

Preferred Qualifications / Knowledge, Skills & Abilities:
• Bachelor’s degree
• AIC, ARM, or CPCU certification, working knowledge of a claims management system.
• Working knowledge of an imaged claims environment.
• Bilingual in English and Spanish.
• Current Experienced Claims Adjuster Designation.

Working Conditions:
• Performs duties in an office environment consisting of computer equipment, phones, consistent temperature and background noise.
• Occasionally fluctuations in pace and priority will occur.
• The temperature is controlled by heating and air components and set to create a reasonable environment for all employees.

Physical Demands:
• While performing the duties of this job the employee is regularly required to sit, stand, use hands to finger, handle, or feel; reach with hands and arms and talk or hear.
• Frequently required to lift, push, pull, twist or otherwise handle items of 10- 25 pounds.
• The vision requirements include: close vision, peripheral, depth, far and near sightedness.

Tools and Equipment:
• Computer and peripherals, standard and customized software, and usual office machines.

Employers - 18 months ago - save job
About this company
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Workers’ compensation insurance for America’s small businesses. For nearly a century, we’ve been providing...