Workers' compensation claims adjuster job description

BCforward is currently seeking for a highly motivated Claims Adjuster - Workers Compensation - at Lake Mary, FL 32746.

Job Title: Claims Adjuster - Workers Compensation

Location: Lake Mary, FL 32746.

Duration: 2+ months

PRIMARY PURPOSE:

To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

· Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.

· Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.

· Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.

· Manages subrogation of claims and negotiates settlements. Communicates claim action with claimant and client.

· Ensures claim files are properly documented and claims coding is correct. May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review. Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

· Performs other duties as assigned. Supports the organization's quality program(s).

· Travels as required.

QUALIFICATIONS

· Education & Licensing Bachelor's degree from an accredited college or university preferred.

· Experience Four (4) years of claims management experience or equivalent combination of education and experience required.

SKILLS & KNOWLEDGE

· Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skill Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations

WORK ENVIRONMENT

· When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

QUALIFICATIONS:

· This is a temporary assignment - - Must have 3-5 years WC claims handling experience multi client desk, Fast paced environment, must be quick study. multiple jurisdictions in multiple southeast states.AL, FL, GA, KY, LA, MS, NC, SC, TN. All Adjuster License, Lines License preferred, FL WC license acceptable.

EDUCATION:

· High School Graduate/GED

Company DescriptionBC Forward began as an IT business solutions and staffing firm. Founded in 1998, BCforward has grown with our customers’ needs into a full-service personnel solutions organization. Headquartered in Indianapolis, Indiana, BCforward also operates numerous delivery centers across North America and India. We are currently the largest consulting firm and largest MBE certified firm in Indiana. Our uninterrupted growth has allowed BCforward to deliver uniquely configured IT staffing and project solutions for over years of catering to our customers’ specific needs. BCforward currently maintains a team of over 5000 global resources. With our additional brand, Stafforward, together we have the capabilities to deliver services for a variety of industries in both public and private sectors which allows us to address your most challenging needs.
www.BCforward.com

**The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.**
Workers Compensation Claims Adjuster (remote to CA residents)

IF YOU CARE, THERE'S A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwick's talented team of 27,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets-their employees, their customers and their property. At Sedgwick, caring counts . Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.

For more than 50 years, Sedgwick has been helping employers answer virtually every question there is about workers' compensation. We have experience in nearly every type of industry and region and provide the industry's broadest range of programs and services.

**PRIMARY PURPOSE** : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Analyzes and processes complex or technically difficult workers' compensation 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.

+ 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.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

+ Supports the organization's quality program(s).

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**WORK ENVIRONMENT**

When applicable and appropriate, consideration will be given to reasonable accommodations.

**Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

**Physical:** Computer keyboarding, travel as required

**Auditory/Visual:** Hearing, vision and talking

**NOTE** : Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

\#LI-GC1

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

Duties & Responsibilities:

• Requires minimal oversight to independently handle all aspects of California workers' compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
• Reviews claim and policy information to provide background for investigation.
• Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers.
• Evaluates the facts gathered through the investigation to determine compensability of the claim.
• Informs insureds, claimants and attorneys of claim denials when applicable.
• Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc.
• Timely administration of statutory medical and indemnity benefits throughout the life of the claim.
• Sets reserves within authority limits for medical, indemnity and expenses and recommends reserve changes to Team Leader throughout the life of the claim.
• Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
• Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.
• Works with attorneys to manage hearings and litigation
• Controls and directs vendors, nurse case managers, telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.
• Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.
• Files workers' compensation forms and electronic data with states to ensure compliance with statutory regulations.
• Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.
• Works with in-house Technical Assistants, Special Investigators, Nurse
  
  Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.
• If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.

Qualifications:

Technical Skills & Competencies:

• Prior experience as a Lost Time Claim Examiner
• Works with a high degree of autonomy and showcases venue expertise
• Serves as a mentor and informal leader to staff with less seniority
• Utilizes influence management skills to drive results, consistency amongst peers and as motivation
• Provides project management
• Serves as a subject matter expert
• Requires knowledge of workers' compensation statutes, regulations, and compliance
• Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues
• Exceptional customer service and focus
• Ability to openly collaborate with leadership and peers to accomplish goals
• Demonstrates a commitment to a career in claims
• Exceptional time management and multi-tasking capabilities with consistent follow through to meet deadlines
• Use analytical skills to find mutually beneficial solutions to claim and customer issues
• Ability to prepare and make exceptional presentations to internal and external customers
• Conscientious about the quality and professionalism of work product and
  
  relationships with co-workers and clients
• Willing to take ownership and tackle obstacles to meet Chubb's quality
  
  standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation
• Superior verbal and written communication skills

Experience, Education & Requirements:

• 5 - 8 years of prior Workers' Compensation Lost Time claim handling experience
• Experience working in a customer focused, fast-paced, fluid environment
• Experience utilizing strong communication and telephonic skills
• Prior experience demonstrating a high level of organization, follow-up and accountability
• AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required
• Experience with litigation management
• Experience with subrogation investigations
• Experience with fraud investigations
• Experience with medical case management
• Knowledge of medical terminology
• Conduct reserve analyses to ensure adequacy
• If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure