Claims Adjuster - Workers' Compensation
Company: Method Workers' Compensation
Posted on: August 4, 2022
The Claims Adjuster is primarily responsible for analyzing workers'
compensation claims to determine benefits due. This role is also
responsible for ensuring the ongoing adjudication of claims within
service expectations, and company best practices pursuant to all
state, legal, statutory, and regulatory bodies in the Midwest
DUTIES & RESPONSIBILITIES
- With minimal supervision investigate claims including but not
limited to, reviewing the first report of injuries, medical
records; contracts; contacting insureds, injured workers, medical
providers, and other parties to determine compensability in a
- Understands, analyzes and applies policy components to evaluate
- Ensure compliance of claims handling requirements pursuant to
all state, legal, statutory and regulatory bodies.
- Exercise discretion and independent judgment with respect to
evaluating and managing claims including determining reserve
amounts and document rationale.
- Evaluate exposure of claims by reviewing medical records and
claim facts to determine causal relatedness of medical
- Manage the medical treatment and return to work process
throughout the life of the claim.
- Adhere to Salus Best Practices, Salus Claims Protocol, and
Claims Handling Guidelines.
- Maintain appropriate claim file documentation and accurate
- Communicate claim activity regularly to any relevant internal
and external stakeholders including injured workers, policyholders,
medical providers, and carriers when appropriate.
- Timely prepare state filings within the state statutory
- Calculate the average weekly wage and indemnity benefits
- Ensure all benefits are paid timely and in accordance with
- Exercise accurate discernment and decision-making to analyze
claims exposure and to plan and document the proper course of
action to move the claim to resolution.
- Coordinate vendor utilization while considering claim cost
containment techniques and outcomes including but not limited to
nurse case management, surveillance, etc.
- Manage claim recoveries including but not limited to Second
Injury Fund, subrogation, and Medicare offsets.
- Notify management of large loss exposure, denial, coverage
disputes, subrogation potential, or other matters requiring
escalation or collaboration.
- Maintain knowledge of jurisdictional requirements and
applicable case law for each State including appropriate licensure
and continuing education requirements.
- Perform other duties as requested and assigned.
- In-depth knowledge of workers' compensation insurance
principles and laws, as well as cost containment
- Strong analytical, critical thinking, and problem-solving
- Detail-oriented with the ability to work in a team
- Excellent customer service, written and verbal communication
- Ability to prioritize and balance multiple projects
- Results-driven, proactive, and able to work
- Ability to exercise discretion and independent judgment
This position will not have supervisory responsibilities.TECHNICAL
Proficient in Microsoft Office Suite, PDF Professional, G Suite, or
WORK ENVIRONMENT & PHYSICAL DEMANDS
Unless fully remote, this 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 with prolonged periods of sitting
at a desk and working on a computer. 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 HOURS
This is a full-time, salaried exempt position. Typical work hours
and days are Monday through Friday, from 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.
Minimal to no travel required.
EDUCATION AND EXPERIENCE
- Bachelor's degree from an accredited college or university
- At least 1-4 years of experience in workers' compensation
claims experience is preferred.
- A combination of education and experience in a TPA or brokerage
environment will be considered
- Nebraska, Illinois, and Iowa (Midwest) jurisdiction experience
- State adjuster's licenses as required
- Medical, Dental, and Vision
- 401k Matching
- HSA Contribution
- 4 Weeks' Paid Maternity Leave
- Hybrid/Remote/On-site Work
- 37.5 Hour Work Week
Method Workers' Compensation is a portfolio of workers' comp
companies with the same mission: minimizing the human and financial
cost of workplace injuries. We mitigate workplace injuries and
deliver exceptional healthcare outcomes for injured workers,
expediting a return to work, preserving families' livelihoods, and
enhancing employers' productivity. We maintain in-house expertise
in claims management, medical bill review, underwriting and loss
prevention for high-hazard, high-mod, and mid-market risks. From
submission to claim, we're there every step of the way, improving
outcomes for everyone involved.
Method currently operates in all non-monopolistic states.
Keywords: Method Workers' Compensation, Lewisville , Claims Adjuster - Workers' Compensation, Other , Lewisville, Texas
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