A worker’s compensation adjuster is responsible for planning and scheduling the work required to process a claim.
Investigation, consulting with other professionals and ensure proper guidelines are followed to mitigate exposure on the claim.
Essential Duties and Responsibilities:
- Responsible for day-to-day handling of workers compensation claims files according to the established claim guidelines and procedures and to provide the best possible claim service
- Ensure and confirm or deny coverage and compensability of claims presented through investigation and contact with claimant, insured and other involved parties.
- Establish appropriate case reserves based on specifics of case according to company guidelines and processes and applicable state requirements.
- Review and make appropriate decisions regarding medical bills, wage claims and other daily claims items to keep file up-to-date.
- Identify subrogation opportunities and refer to appropriate parties.
- Refer file to appropriate parties for medical management, special investigative needs, etc. and monitor status of work performed.
- Manage files in litigation and review quality of outside counsel participation.
- Negotiate claims for settlement as needed within assigned authority levels.
- Ensures compliance with material within procedural guidelines including keeping all reports (diary, EDI, excess, review reports) within NCA Standards.
- Able to participate in additional projects including training, triage of new claims and any other special projects.
Required Education and Experience:
High school diploma is necessary. An Independent Adjusters license is necessary.
Physical Demands and Working Conditions:
Normally, physical demands are typical of an office environment.