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Sr. Work Comp Claims Adjuster (SIP required)
Fresno, CAPOSITION SUMMARY: Under general supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.
This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Adjusters, and other COMPANY staff.
DUTIES AND RESPONSIBILITIES:
Education/Experience: Bachelor’s degree in a related field (preferred); and one (1) to five (5) years of related experience; or equivalent combination of education and experience.
Knowledge, Skills, and Abilities:
Other Qualifications:
This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Adjusters, and other COMPANY staff.
DUTIES AND RESPONSIBILITIES:
- Effectively manages a caseload of 150 to 180 workers compensation claims, including complex claims.
- Initiates and conducts claims investigation in a timely manner.
- Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.
- Manages medical treatment and medical billing, authorizing as appropriate.
- Refers cases to outside defense counsel as appropriate. Monitors legal aspects.
- Communicate with claimants, providers, and vendors regarding claims issues.
- Computes and sets reserves within Company guidelines. Limits are less than those allowed for Claims Adjuster III but larger than those for Claims Adjuster I.
- Settles and/or finalizes all claims and obtains authority as designated.
- Maintains diary system for case review and document file to reflect the status and work being performed on the file.
- Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.
- Involves COMPANY loss control staff when appropriate.
- Adheres to all Company policies and procedures.
- Participates in file reviews, as needed.
- Other duties as assigned.
Education/Experience: Bachelor’s degree in a related field (preferred); and one (1) to five (5) years of related experience; or equivalent combination of education and experience.
Knowledge, Skills, and Abilities:
- Technical knowledge of statutory regulations and medical terminology.
- Analytical skills.
- Excellent written and verbal communication skills, including the ability to convey technical details to claimants, clients, and staff.
- Ability to interact with persons at all levels in the business environment.
- Ability to independently and effectively manage very complex claims.
- Proficient in Word and Excel (preferred).
Other Qualifications:
- SIP certification.