Senior Claims Adjuster I

Title: Senior Claims Adjuster I

Location: United States (Florida)

Job Description:

Senior Claims Adjuster I - Florida| 100% Remote (WFH)

General Summary

With minimal oversight, the Senior Claims Adjuster I is responsible for the timely and accurate management of workers' compensation claims in Florida. This includes handling medical and indemnity benefits, addressing litigation and complex issues, and managing moderate to high exposure cases.

Essential Duties and Responsibilities

• Completes initial contacts to obtain necessary information, verify coverage, determine compensability and develop a plan of action. Completes and maintains claim data integrity.
• Independently analyzes case facts to establish timely and accurate reserves using knowledge and experience with medical disabilities and related costs, as well as judgment of extent of disability.
• Collaborates with Corporate Claims to proactively evaluate and mitigate high exposure losses.
• 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 manages or coordinates medical treatment to continue to move the claim forward. Uses internal and external resources to contain costs and manage exposure.
• Reviews and analyzes litigation and legal issues. Directs legal strategy and participates in preparation of the case for litigation. Collaborates with defense attorney to move claims to resolution.
• Completes detailed settlement analysis and recommends appropriate settlement value, utilizing in-depth knowledge of appropriate workers’ compensation insurance principles and laws, subrogation recoveries, offsets and deductions, claim and disability duration, cost containment principles; including medical management practices and Social Security and Medicare application procedure as applicable.
• Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure. Uses a high degree of independent judgment to render accurate decisions.
• Mentors other team members and acts as a Subject Matter Expert for legal, jurisdiction and Company needs.
• Other duties as assigned.

 

Requirements

• 7 or more years of related claims experience including complex claim handling. Internal candidates with proven results may also qualify.
• Superior communication and customer service skills and proficiency in 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 the ability to work independently with minimal direction. The ability to multi-task and prioritize, adhere to deadlines and complete assignments accordingly.
• Excellent analytical, problem solving and decision-making skills.
• Equivalent combinations of education and experience may be considered.

Certification

• WCCP, AIC, ARM, CPCU or other insurance designation preferred.

Education

• Bachelor’s degree or equivalent business experience preferred.

Work Environment:

• Remote: This role is a remote (work from home (WFH) opportunity, and only open to candidates currently located in the United States and able to work without sponsorship.
  • It requires a suitable space that provides a private and quiet workplace.
• Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
• Travel: May be required to travel to off-site location(s) to attend meetings, as necessary 

Salary Range:  $70,000 - 106,000 and a comprehensive benefits package, please follow the link to our benefits page for details! EMPLOYERS Benefits