Sr. Work Comp Claims Adjuster (PA & NJ) Job at Elite, Philadelphia, PA

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  • Elite
  • Philadelphia, PA

Job Description

Job Title: Sr. Workers Compensation Claims Adjuster

POSITION SUMMARY: 
Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. 

DUTIES AND RESPONSIBILITIES:
  • Adjuster can work from the Philadelphia, PA office or can work remotely from home if approved by hiring manager.
  • Effectively manages a caseload of 125 to 150 workers’ compensation files, including very complex claims.*
  • Jurisdiction is PA, NJ*
  • Initiates and conducts investigation in a timely manner.*
  • Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.*
  • Manages medical treatment and medical billing, authorizing as appropriate.*
  • Refers cases to outside defense counsel. Directs and manages as appropriate.*
  • Communicates with claimants, providers and vendors regarding claims issues.*
  • Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Adjuster I and Claims Adjuster II.*
  • Settles and/or finalize 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.*
  • Involves COMPANY loss control staff when appropriate.*
  • Adheres to all Company policies and procedures.*
  • Conducts file reviews independently.*
  • Other duties as assigned.
* Essential job function.

QUALIFICATIONS REQUIRED:

Education/Experience : Bachelor’s degree in related field (preferred); three (3) 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).
Other Qualifications :
  • No licenses required for the state of PA or NJ

Job Tags

Work at office, Remote work,

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