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Workers' Compensation Claims Adjuster (Non-Subscriber)

Company: Salus Workers Compensation LLC
Location: Lewisville
Posted on: November 22, 2021

Job Description:

Description:
Summary/ObjectiveUnder the leadership of the VP, Claim, the Claims Adjuster is responsible for investigating, analyzing and evaluating claims to determine if the benefits due are consistent with a client's Work Injury Benefit Plan and/or potential employer's liability claims. Additionally, the Claims Adjuster is to identify if there is a subrogation potential and negotiate settlements to ensure ongoing adjudication of claims within service expectations, industry, and company best practices.Essential FunctionsReview and understand assigned client Work Injury Benefit Plans.Promptly investigates, evaluates, and manages claim compensability determination and recoveryManages the medical and return to work process throughout the life of the claimEvaluate severity of claims by review of medical records to develop and calculate appropriate reserves and manage reserve adequacy throughout the life of the claimAdhere to Salus Best Practices and Salus Claims ProtocolEnsure appropriate claim file documentation and claim coding is complete and accurateCommunicate claim activity regularly to any relevant internal and external stakeholders, including injured worker, policy holder, medical provider, and legal counsel if appropriatePrepares timely state filings within the state statutory regulationsCalculate the average weekly wage and indemnity benefits owed as well as approve medical and expense payments. Ensure all benefits are paid timelyEnsure timely and cost-effective claims resolution; negotiate settlement of claims within adjusters assigned authority when appropriateManage the litigation process and work with legal counsel when necessaryCoordinate vendor utilization while considering claim cost containment techniques and outcomesManage claim recoveries to include but not limited to subrogation, and Medicare offsets including but not limited to nurse case management, surveillance, etc.Notify management of large loss, denial, coverage disputes, subrogation potential or other matters requiring escalation or collaborationPerform other duties as requested and assignedCompetenciesIn-depth knowledge of insurance workers' compensation or non-subscription principles and laws, recovery, off-sets, deductibles, cost containment principles including medical management, Social Security and Medicare application proceduresExcellent customer servicesExcellent judgment, troubleshooting, and problem-solving skillsExcellent written and verbal communication skillsDetailed oriented with the ability to handle multiple priorities simultaneously while meeting deadlinesExcellent collaboration skills working in a team environmentSupervisory ResponsibilityThis role has no supervisory responsibilities..

Requirements:
Technical Skills RequiredProficient in Microsoft Office Suite, G Suite, or similar softwareWork Environment & Physical DemandsThis position operates in a professional office setting and routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. This is largely a sedentary role; however, some filing is necessary and may require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary.Position & Expected HoursThis is a full-time, salaried exempt position. Typical work hours and days are Monday through Friday, 8:00 am to 5:00 pm. Some flexibility in hours is allowed, however the employee must be available during the "core" work hours of 9:30 am to 3:30 pm and must work 37.5 hours each week.TravelNo travel required.Required Education & ExperienceA bachelor's degree from an accredited college or university is preferred.At least five years of experience working with at least one of WC, Non-Subscription or Long Term Disability claims.A combination of education and experience may be accepted.Texas adjuster's license required.PI153253278

Keywords: Salus Workers Compensation LLC, Lewisville , Workers' Compensation Claims Adjuster (Non-Subscriber), Other , Lewisville, Texas

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