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Summary:
The main function of a Claims Adjuster is to investigate, analyze, and determine the extent to which an insurance company is liable and to determine how much compensation is needed/required. •5 years' Claims Adjuster - Workers Compensation experience handling California Claims
Job Responsibilities:
•Analyze first reports of injury to determine nature of injury and what benefits are owed based on the statute.
•promptly contact insureds, injured workers and medical providers.
•Maintain contact with insured, injured workers or their representative, and providers for the duration of their claim and promptly update all parties as their claim develops.
•Promptly and properly develop the file to provide accurate and timely investigation and loss analysis.
Strict adherence to jurisdiction rules regarding form notices to injured worker, insured and state court
Timely and appropriately calculated benefits paid in accordance with jurisdiction
•Maintain an active diary; monitor diary to achieve timely development of file and timely disposition of the claim;
•Recognize and pursue recovery where possible; adhere to all statutory regulations and unfair claim practices act;
•Effectively communicate with all internal and external customers
Skills:
•Knowledge of insurance contracts, investigative techniques, legal requirements and regulations. No licenses needed
•Ability to work with a wide spectrum of people;
•Develop and maintain strong business relationships with internal and external customers;
•Ability to calculate statutory benefits owed and understand formulaic math
Ability to work within tight deadlines
Strong organizational skills to respond to inquiries from a variety of sources
If possible, insurance carrier background is a nice to have, not just TPA experience
Being familiar with presenting case analysis at Claim reviews, is a plus
•Excellent written and verbal communication skills;
•Customer service orientation; strong analytical and negotiation skills.
Education/Experience:
•5 years' Claims Adjuster - Workers Compensation experience handling California Claims