Workers Compensation Claims Adjuster

Workers Compensation Claims Adjuster

The James Allen Companies Inc
Published
February 19, 2019
Location
Irvine, CA
Category
Claims  
Job Type

Description

Claims Department

Reports to the Vice President and Senior Vice President, Claims

Summary and Purpose

Investigate, manage and resolve claims in a timely, unbiased and informed manner in compliance with company policies, state laws and regulatory performance standards.

General Responsibilities

  • Knowledge of policy documents for coverage verification.
  • Provide account servicing support on claim issues to policyholders.
  • Investigate, determine compensability, and manage time loss claims consistent with jurisdictional requirements.
  • In-person meetings with injured workers, employers, and medical providers
  • When necessary, assign investigators, attorneys, medical consultants and others to facilitate claim determinations and plan of action.
  • Follow up with claimants, policyholders and medical providers to monitor progress.
  • Answer questions regarding the status of pending claims from claimants, policyholders and medical providers.
  • Consult with attorneys regarding litigation management, settlement strategy and claim resolution.
  • Assist clerical staff in completion of workers' compensation forms in conformance with jurisdictional requirements.
  • Maintain electronic and paper files necessary for documentation of the claim file to include coding, contacts, financial data and plan of action.
  • Review reserves for appropriateness and file timely reports on all serious loss claims as required by policy and regulatory standards.
  • Participate in department training.
  • Provide direction and supervision to assigned clerical staff.
  • Perform other duties as assigned.

Minimum Requirements

  • High school graduate, college degree preferred
  • Two years of college courses or equivalent industry experience
  • One year of Workers' Compensation adjusting experience
  • Fundamental knowledge of maritime and USL&H jurisdictions
  • Knowledge of medical and legal terminology and procedures
  • General computer skills

Attributes

  • Excellent written and verbal communication skills
  • Strong inter-personal skills
  • Effective negotiation skills
  • Ability to prioritize workload to meet deadlines
  • Ability to work well in a team environment

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