Client: Insurance Domain
Job Title: Claims Adjuster - Workers Compensation (Hourly)
Location: 100% Remote
Duration: 3 months
Pay Rate: $47.50/ hr (W2 without benefits)
Manager's note:
Duration of project: 3 months plus possibility of extension
Mandatory: Workers Comp experience in Southeast state jurisdictions some or all AL. GA, FL, NC, SC, TN
Experience: 5+ years of relevant WC experience with above mentioned states.
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.
QUALIFICATION
Bachelor's degree from an accredited college or university preferred.
Professional certification as applicable to line of business preferred.
Five (5) years of claims management experience or equivalent combination of education and experience required.
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
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.
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