Claims Adjuster - Workers Compensation - Apidel Technologies

Description:Hiring Manager\'s note:

Any specific skill/ certification/ license:

SIP preferred but not required

Years of experience:

prefer 2 or more

WC Claims Examiner

PRIMARY PURPOSE:

To analyze mid- and higher-level workers compensationclaims to determine benefits due; to ensure ongoing adjudication of claimswithin company standards and industry best practices; and to identifysubrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Manages workers compensation claims determiningcompensability and benefits due on long term indemnity claims, monitors reserveaccuracy, and files necessary documentation with state agency.

Develops and manages workers compensation claims\' actionplans to resolution, coordinates return-to-work efforts, and approves claimpayments.

Approves and processes assigned claims, determinesbenefits due, and manages action plan pursuant to the claim or client contract.

Manages subrogation of claims and negotiates settlements.

Communicates claim action with claimant and client.

Ensures claim files are properly documented and claimscoding is correct.

May process complex lifetime medical and/or definedperiod medical claims which include state and physician filings and decisionson appropriate treatments recommended by utilization review.

Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

Supports the organization\'s quality program(s).

Travels as required.