Workers' Compensation Adjuster

We are seeking a motivated detail-oriented Workers Compensation Adjuster to joint our home health care organization. This role will work closely with injured employees office leadership and our Third-Party Administrator (TPA) to support the day-to day-management of Workers Compensation claims while helping ensure injured employees receive timely care and support.

This is an excellent opportunity for someone early in their Workers Compensation or claims career.

POSITION SUMMARY: Under moderate supervision will perform a variety of functions related to the management of the companys Workers Compensation claims and other aspects of the Employee Claims and Safety office (ECS) through: 1) hands on management and creation of policies and practices 2) preparing reports analysis and presentations and 3) providing administrative and project support to your supervisor.

MINIMUM QUALIFICATIONS:

• Four (4) year college degree preferred.
• Minimum two (2) years of experience in Workers Compensation claims handling.
• Basic proficiency in handling litigated Workers Compensation claims.
• Demonstrated proficiency in effectively and timely communicating with service offices injured employees and Third-Party Administrator.
• Demonstrated record of strong interpersonal skills.
• Proven record of goal achievement.
• Able to handle multiple tasks.
• Ability to arrange information and files in a useful manner.
• Proficient in Microsoft computer products including Word Excel PowerPoint and Outlook.
• Acceptable pre-employment assessment results.
• Ability to read write and effectively communicate in English.

PRIMARY RESPONSIBILITIES:

• Learn various aspects of the organization through technology training hands-on learning cross-training and site visits.
• Ensure accurate completion of clerical functions such as the routine maintenance of reliable claim notes records and reports.
• Understand the companys policies as well as the applicable state Workers Compensation laws that govern our work.
• Act as a trusted advisor and become a subject matter expert with regard to Employee Claims functions and processes.
• Support the team (office and company) and provide backup as needed.
• Provide customer service for routine claim questions and direct more complex issues to BAYADAs third party administrator.
• Handle a caseload between seventy-five (75) and one hundred fifty (150) active Workers Compensation claims while maintaining accurate and complete information on each assigned file.
• No greater than 5% of caseload will be valued at greater than BAYADAs current deductible.
• Proficiency in infectious disease claims and communicating and implementing the associated BAYADA policies.
• Ensure that each BAYADA office has a reliable Panel List of Providers and maintain regular contact with office directors to guarantee continued satisfaction with ECSs outside medical vendors.
• Ensure that each work-related injury is reported within the states filing deadline.
• Obtain timely medical reports from claimants treating physicians and promptly inform BAYADA office staff of the findings.
• Schedule follow-up appointments for any claimant who misses a regularly scheduled medical visit.
• Coordinate placement of injured workers in modified or light-duty placements as directed by their treating physician; seek alternate work assignments for claimants if job opportunities do not exist within the company; facilitate completion of the companys light-duty payroll on a weekly basis.
• Timely investigation of claims.
• Appropriate and accurate coding of claims.
• Continue to develop knowledge base of claims handling and jurisdictional knowledge through claims handling and independent research.
• Timely completion of Action List items.
• Ability to accurately evaluate and present settlement evaluations/recommendations.
• Proven ability to progressively work in a more independent fashion with moderate direction.
• Proactively works and collaborates with Third Party Administrator (TPA) and defense counsel to create effective strategies.
• Ongoing analysis of exposure and recommendations for mitigating the exposure and resolution of the claim is evidenced.
• Identification of and escalation of Third-Party Administrator service issues through to resolution.
• Continuously evaluate defense counsel and other strategic partnerships to ensure effectiveness and address issues as needed.
• Assist in the creation and management of policies practices and procedures related to BAYADAs Employee Claims and Safety office.
• Initiate and independently research claim information through compilation of statistics analyzing data and summarizing findings for review.
• Participate in special projects: prepare reports and presentations using Microsoft Office (Word PowerPoint etc.)