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Sr. Workers Compensation Claims Adjuster (NM License)

  • Albuquerque, NM
Position: Sr. Workers Compensation Claims Adjuster (NM License)
Salary: $88,000 to $94,000 (depending on experience)
Type: Hybrid (2-days/wk in-office)

DUTIES AND RESPONSIBILITIES:
 
  • Effectively manages an average caseload of 130 workers’ compensation files, including very complex claims.*
  • Initiates and conducts investigation in a timely manner.*
  • Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.*
  • Develops and manages claims through well-developed action plans; continues to work the action plan to stay on task and to bring the claim to an appropriate and timely resolution.
  • Manages medical treatment and medical billing, authorizing as appropriate.*
  • Calculates and pays benefits due and approves all claim payments.
  • Refers cases to outside defense counsel.  Directs and manages as appropriate.*
  • Manages claim recoveries of all types, including deductible and subrogation. 
  • Communicates with clients, claimants, providers and vendors regarding claims issues.*
  • Computes and set reserves within Company guidelines.*
  • Settles and/or finalizes all claims and obtains authority as designated.*
  • Maintains diary system for case review and documents 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.*
  • Adheres to all Company policies and procedures.*
  • Conducts file reviews independently.*
  • Other duties as assigned.
* Essential job function.

EQUIPMENT OPERATED/USED:  Computer, 10-key, fax machine, copier, printer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING:  Appropriate office attire

QUALIFICATIONS REQUIRED:

Education/Experience:  Bachelor’s degree in related field (preferred); five (5) or more years 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 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).
  • Knowledge of self-insured claims handling (preferred).
  • City, County and/or District claims handling experience (preferred).
Other Qualifications: 
  • New Mexico adjuster’s license required