Senior Workers Compensation Claims Adjuster
Senior Workers Compensation Claims Adjuster
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Job Description
Job Details
Description
Integrity. Care. Trust. Compassion. Expertise.
Do these words resonate with you
These values of Builders culture create success in all we do. We strive to provide deeply supportive partnerships to our customers agents and each other.
Builders is proud to be named among the Great Places to Work. Our award-winning culture has earned top marks in Company Direction Employee Appreciation Work-Life Balance Leadership and Compensation and Benefits. Our strong culture keeps us Built Strong in a forever-changing world and our AM Best A Rating is evidence of our financial strength.
Position Summary
The Senior Claims Adjuster determines compensability sets reserves and approves payment in accordance with industry and company Claims best practices. The Senior Adjuster analyzes and interprets statues and regulations applicable to case facts in order to render appropriate legal and ethical decisions while managing claims in a prompt and thorough manner from inception through closure.
Responsibilities
- Manage a caseload of limited coverage and medium to severe claims with authorization to resolve cases within a designated monetary threshold. Develop and implement impactful strategies to negotiate and resolve claims within established parameters. Strive to achieve fair and equitable outcomes while steadfastly upholding company and departmental protocols and standards.
- Deliver quality customer service to all parties involved in the claim process ensuring prompt and efficient delivery of appropriate benefits. Actively participate in meetings or visits with agents insurers and policyholders to cultivate professional relationships and facilitate effective issue resolution.
- Conduct investigations into losses utilizing various techniques such as interviews recorded statements and thorough documentation. Diligently gather and preserve evidence.
- Identify opportunities for subrogation or instances of potential fraud. Verify analyze and apply coverage correctly to each case based on a thorough analysis of facts and pertinent statutory case law. Scrutinize bills determine necessary actions and process claims accordingly prioritizing cost-effective resolutions.
- Prepare concise and timely reports to facilitate efficient claims processing. Keep agents insurers agency operations and the corporate Claims Department informed of file status and pertinent developments. Ensure accurate and timely filing of all state forms required for claims processing; prepare necessary reports for large loss and reinsurance carriers.
- Establish reserves and authorize payments in alignment with established procedures.
- Scrutinize contracts to evaluate risk transfer and assess duty to defend and indemnify additional insured parties.
- Manage the litigation process in an efficient and effective manner. Determine the necessity for and provide guidance to defense counsel independent adjusters or technical experts while monitoring and managing their expenses. Attend hearings pre-trial settlements conferences and trials.
- Assess the need for independent medical evaluations second opinions nurse or physician reviews and make referrals. Evaluate the need for external services such as surveillance field adjusters or field case managers or coordinating referrals.
- Maintain detailed documentation of claims activity in claim notes regularly reviewing and updating diaries and claim notes for all open claims.
- Meet or exceed expected quality performance guidelines to uphold service standards.
- Participate in professional development through training programs to stay updated on workers compensation laws rules and regulations.
- Identify cases necessitating large loss and/or reinsurance reports ensuring comprehensive management.
- Conduct thorough file reviews at various stages of the claims process.
- Contribute to the training of workers compensation claim staff under the guidance of management.
- Serve as a technical expert and offer support to management.
- Monitor litigated files to ensure adherence to litigation management protocols.
- Utilize Insurance Service Office (ISO) decision net and claim search inquiries.
- Respond to complaint calls and other inquiries excluding those related to Department of Insurance (DOI) complaints with professionalism and efficiency.
- Performs other duties as assigned.
Qualifications
- Bachelors degree or equivalent combination of education and/or experience in the insurance field
- Five or more years of workers compensation experience including complex case processing
- Licensed in multiple jurisdictions with a professional claims designation
- Knowledge of applicable state laws across territories of operation
- Knowledge of claims policy procedures fiduciary guidelines and best practices
- Skill in interpersonal interactions with the ability to collaborate effectively with individuals at all organizational levels and with external stakeholders; skill in customer service problem-solving time management and conflict resolution
- Capacity to work autonomously while ensuring transparent communication with internal leadership
- Skill in planning time and organizational management; ability to multi-task effectively while paying attention to detail
- Proficient in both verbal and written communication with the ability and commitment to maintain confidentiality
- Proficient with Microsoft Office Suite and function specific software applications
Lets talk benefits!
- Competitive Salary
- Bonus Structure
- Profit Sharing
- Medical Dental Vision Insurance
- Employer Paid Short Term Disability
- Employer Paid Long Term Disability
- Employer Paid Life Insurance
- Voluntary Life Insurance
- 401K with Company Match
- PTO
About Builders
Builders is a mid-sized mutual with remarkable strengths. Rated A by AM Best Builders has forged rock-solid financial strength and a reputation for reliability and fairness in fulfilling our promises to customers. Kind collaborative and customer-centric our experienced and passionate teams foster a rewarding atmosphere of excellence trust and mutual respect meriting the Culture Excellence honors from Top Workplaces. Flexible and highly personal our experts leverage deeply supportive partnerships with knowledgeable independent agencies to drive better services and protection for policyholders.
Our financial excellence amazing people and powerful partnerships build outstanding outcomes and peace of mind for our agents and their clients. This is what we mean by Insurance Built Strong.
Builders Insurance Group is an Equal Opportunity Employer. We welcome applicants from all walks of life and dont discriminate based on any protected status. Join us in creating a diverse and inclusive workplace! If during the application process you need assistance or an accommodation due to a disability please contact .
Required Experience:
Senior IC
Employment Type
Unclear
