Job Description

Claims Adjuster - Workers Compensation

Our client, a Business Solutions company, is looking for a Claims Adjuster - Workers Compensation for their Las Vegas, NV/Remote location. Responsibilities include:

• Analyzing mid- and higher-level workers compensation claims to determine benefits due; ensuring ongoing adjudication of claims within company standards and industry best practices; and identifying subrogation of claims and negotiating settlements.
• Managing workers compensation claims determining compensability and benefits due on long term indemnity claims, monitoring reserve accuracy, and filing necessary documentation with state agency.
• Developing and managing workers compensation claims' action plans to resolution, coordinating return-to-work efforts, and approving claim payments.
• Approving and processing assigned claims, determining benefits due, and managing action plan pursuant to the claim or client contract.
• Managing subrogation of claims and negotiating settlements.
• Communicating claim action with claimant and client.
• Ensuring claim files are properly documented and claims coding is correct.
• Processing complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintaining professional client relationships.
• Performing other duties as assigned.
• Supporting the organization's quality program(s).

Requirements include:

• Bachelor's degree from an accredited college or university preferred.
• Four (4) 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.
• Strong organizational skill.
• Good interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Service Expectations.

Work Environment:

• When applicable and appropriate, consideration will be given to reasonable accommodations.
• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
• Physical: Computer keyboarding.
• Auditory/Visual: Hearing, vision and talking.

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities

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