Workers' Compensation Claims Adjuster

Description

Job Title: Workers’ Compensation Claims Adjuster

Department: Workers’ Compensation

Reports to: Claim Operations Manager

Position Summary: This is an office position responsible for the adjudication of workers’ compensation claims, assigned by our clientele, in accordance with the Arizona and Colorado Workers’ Compensation Statutes, governing rules and regulations, related case law and client and company procedures. New loss assignments are account driven, based on case complexity and experience levels of the adjuster.

Fully remote work for applicants located outside of the Albuquerque area. 

Essential Functions:

• Investigate new claims to verify claim information including but not limited to: injury/accident history and determination of compensability. This includes 3 point contact, interviewing employer, employees, witnesses; taking recorded statements; coordination of medical treatment and identifying subrogation opportunities.
• Demonstrate the ability to complete claim documentation in company CMS and/or other client proprietary computer claim systems utilized. This position is responsible for reporting to clients per their specific guidelines. Must be familiar with a diary system and keep all open files maintained on that diary.
• Strong analytical skills for proper posting and monitoring of reserves for medical, indemnity and expense lines pursuant to client instructions and or company best practice standards.
• Timely review and payment of medical bills and issuance of indemnity benefits per Statutory requirements. Must demonstrate proficiency in the application of state statutes, related case law and the ability to interpret and comply with client and company standards, policies and procedures.
• This position is responsible for making required legal filings; state filings through EDI. Ensure that proper outside vendors referrals are made and properly justified. Attend legal proceedings, mediations and hearings. Represent the client and company at trail.
• Address return to work issues and strategies to mitigate lost time exposures. Evaluate medical records / reports and calculate impairment and modifiers benefits as applicable. Identify strategies for claim settlements.

Job Qualifications:

Education: High school diploma required. Bachelor’s degree from an accredited college or university preferred.

Experience: A minimum of five years workers’ compensation claims experience working with an insurance company or third-party administrator. Additional relevant experience considered in lieu of education.

Required Skills/Abilities:

• Demonstrate expertise investigating, evaluating and negotiating workers’ compensation claims required.
• Demonstrate advanced knowledge of complex medical issues.
• Possess outstanding customer service and conflict resolution skills.
• Strong presentation and negotiation skills.
• Attention to detail and accuracy.
• Excellent oral and written communication skills.
• Ability to build and maintain relationships with internal and external stakeholders.
• Technologically savvy, able to navigate current computer system; proprietary client systems and internet programs with speed and efficiency.
• Excellent organization skills which includes ability to multi-task and prioritize.
• Must be a self-starter with the ability to work independently and as part of a team.

Specialized Knowledge, Licenses, etc.:

Demonstrated proficiency in:

• Professional designations, such as AIC, ARM, CPCU (Preferred but not required)
• Ability to obtain Arizona Workers’ Compensation Adjuster License (Required)
• MS Word and Outlook (Required) MS Excel and PowerPoint (Preferred)
• Adobe (Preferred)

Values and Mission:

Adhere to values and mission by demonstrating Service Excellence, Trust, Ownership, One team and Boldness in thought and action.

Positive Attitude:

Develops and maintains positive working relationships with team members, customers, co-workers and management by demonstrating effective communication and collaborative skills.

Working Conditions:

• Integrion Group maintains general office conditions with light physical demands.
• Employees of Integrion Group adhere to all safety rules and regulations including building security.
• Employees participate in ensuring safe and efficient operating conditions that safeguard employees and facilities.
• Integrion Group maintains a drug free environment; drug testing prior to employment as well as upon a work related accident
• Exposure to VDT screens.