Senior Workers’ Compensation Adjuster

Southern Company

Atlanta, GA

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JOB DETAILS

SKILLS

Analysis Skills, Automation, Billing, Business Skills, Business Solutions, Centers for Medicare and Medicaid Services (CMS), Claims Management, Claims Processing, Communication Skills, Compensation and Benefits, Conferences, Corporate Policies, Cost Control, Customer Satisfaction, Customer Support/Service, Detail Oriented, Documentation, Environmental Economics, Expense Management, Facebook, Federal Laws and Regulations, Fiber Optics, Financial Analysis, Funding, Genetics, Healthcare, Healthcare Providers, Healthcare Quality, Healthcare Reimbursement, High School Diploma, Human Resources, Incentive Programs, Industry Standards, Insurance, Leadership, Legal, Litigation, Maintain Compliance, Medical Writing, Medicare, Microsoft Excel, Microsoft Outlook, Microsoft Product Family, Microsoft SharePoint, Microsoft Word, Natural Gas, Negotiation Skills, Oil and Gas, Oracle, Patient Care, Payment Processing, Pharmacy, Problem Solving Skills, Reimbursement, Safety/Work Safety, State Laws and Regulations, Stewardship, Subrogation, Sustainability, Team Player, Telecommunications, Time Management, Twitter, Vendor/Supplier Management, Vendor/Supplier Relations, Wind Power

LOCATION

Atlanta, GA

POSTED

5 days ago

**JOB SUMMARY:** This position is responsible for a variety of professional duties in handling workers’ compensation claims in Georgia for Georgia Power, along with handling claims in Georgia for Southern Company Services, Southern Power, and Southern Communications, and providing backup workers’ compensation claim support for Southern Nuclear Company in both Georgia and Alabama. This role is responsible for investigating, analyzing, and managing claims, including determining compensability, handling indemnity, medical, financial exposure and payments, state form filings, Medicare reporting, working with defense counsel on legal/litigation issues, subrogation actions, excess/re-insurer reporting, Subsequent Injury Trust Fund (SITF) reporting, and other miscellaneous tasks. This role requires timely and thorough communication with a variety of stakeholders. This role requires a strong compliance component to follow federal laws and guidance, state laws and rules, and company processes and policies in handling claims. **Please Note: This is a hybrid position with in-office presence expectation at 241 Ralph McGill Blvd, Atlanta, GA.** **JOB REQUIREMENTS:** **Education** : + High School Diploma Required + Associate Degree or Bachelor's Degree Desired **Work Experience:** + Minimum 5 years claims related experience in handling complex workers’ compensation claims required + Ideal candidate will have claims experience in Georgia and Alabama + Knowledge of accepted industry standards and practices **Preferred:** + Experience as a lost-time adjuster for a Third-Party Administrator or Self-Insured Company for 5+ years **MAJOR JOB RESPONSIBILITIES:** **Functional Expertise:** + Partners with **employees, leadership, Medical & Health Services, Safety, medical providers, vendors, and legal counsel** to effectively manage and resolve claims + Determines **compensability** and manages claims in accordance with **Alabama and** **Georgia Workers’ Compensation laws, rules, and company policies** + Collaborates with **external defense counsel** to investigate claims and evaluate compensability based on case-specific facts and circumstances + Serves as a **cross-trained resource** supporting **Southern Nuclear Workers’ Compensation claims** across **Georgia and Alabama jurisdictions** to ensure continuity and consistency + Applies **professional judgment** to manage a broad range of **complex claim types** , including medical-only, lost-time, catastrophic, death, controverted, and litigated claims + Calculates, analyzes, and manages **claim financials** , including **historical spend** and **future reserve estimates** + Ensures **timely and accurate processing of payments** , including indemnity, medical, legal, and related expenses + Identifies and proactively pursues **claim resolution opportunities** , including **return-to-work strategies, settlements, and appropriate benefit discontinuation** + Evaluates claims for **cost containment opportunities** while ensuring appropriate and quality medical care + Coordinates **reimbursement and recovery efforts** , including **excess insurance, Subsequent Injury Trust Fund, and subrogation opportunities** + Communicates with **Payroll** to ensure proper handling of **indemnity offsets and salary-in-lieu payments** + Maintains accurate and detailed **claim documentation** , including **notes, action plans,** and **supporting information** within claim systems + Ensures compliance with all **state and federal reporting requirements** , including **Georgia State Board filings and Medicare Section 111 reporting and CMS requests** + Supports required **annual filings** , including reporting for the **State Board of Workers’ Compensation and the Self-Insured Guaranty Trust Fund** + Coordinates **Medicare Set-Aside (MSA)** **reporting and funding** and facilitates arrangements and communications + Manages **vendor setup processes** , including requesting W-9s and obtaining billing information for payment processing + Oversees **medical management activities** , including **bill review approvals** , **pharmacy benefit management requests** , and **processing of employee reimbursements** (e.g., mileage, out-of-pocket expenses) + **Utilizes automation tools** , including Power Automate, to support and streamline workflows where appropriate + Builds and maintains strong working relationships with **external vendors** , ensuring timely communication, responsiveness, and issue resolution + Demonstrates the ability to quickly learn and effectively utilize **claim systems and business applications** , including **Assure Claims, ICMS II, Oracle, Mobi, Medicare Section 111 reporting tools, third-party medical and pharmacy platforms, and Microsoft 365 applications (Outlook, Excel, Word, Forms, SharePoint, OneNote, Power Automate),** with the expectation of ongoing learning as systems and processes evolve **Litigation:** + Serves as **Company Representative** for claims, including providing testimony at **hearings, depositions, mediations, and other legal proceedings** + Partners closely with **defense counsel** by providing **timely documentation, claim updates, and case strategy support** + Prepares and presents **settlement evaluations** to management to obtain appropriate **settlement authority** , and leads **negotiations to resolve claims** + Evaluates claims for **closure opportunities** and develops **resolution strategies** + Negotiates settlements with **pro se claimants** and **supports counsel** with requests in order to finalize settlement documentation and agreements + Coordinates **subrogation efforts** with **motor vehicle insurers and legal representatives** when third-party liability exists + Communicates directly with **opposing counsel** , when appropriate, to support **timely resolution and cost management of legal expenses** **Business Acumen:** + Identifies, evaluates, and actively pursues **reimbursement and recovery opportunities** + **Calculates, reviews, and analyzes claim financials** , including estimating and managing future reserves + **Balances attention to detail** with the ability to **effectively manage a high-volume caseload** + Maintains **comprehensive claim documentation** , including detailed notes and clear action plans + **Adapts quickly** to evolving processes, systems, and workflows + **Builds and maintains** **strong, professional relationships with internal and external stakeholders** , ensuring timely and appropriate responsiveness + **Collaborates with internal teams and external partners** to resolve issues, process claims efficiently, complete required documentation, and bring claims to timely resolution + **Quickly learns** new processes, documents key information through effective notetaking, and applies knowledge to daily work + Demonstrates **strong problem-solving skills** and the ability to **develop effective solutions** in complex or unique situations + **Communicates clearly and professionally in writing** , including drafting medical questionnaires and correspondence to physicians + Exhibits **excellent communication skills** and works effectively in a collaborative team environment + **Manages** **calendars, diaries, and plans of action** to ensure timely claim handling and compliance with deadlines + Demonstrates a **continuous learning mindset** **and adaptability** as processes and business needs evolve + Available and responsive to **after-hours calls** on a limited, as-needed basis + **Available to travel** to offsite meetings, conferences, etc. as needed **Georgia Power** is the largest electric subsidiary of Southern Company (NYSE: SO), America's premier energy company. Value, Reliability, Customer Service and Stewardship are the cornerstones of the Company's promise to 2.6 million customers in all but four of Georgia's 159 counties. Committed to delivering clean, safe, reliable, and affordable energy at rates below the national average, Georgia Power maintains a diverse, innovative generation mix that includes nuclear, coal and natural gas, as well as renewables such as solar, hydroelectric and wind. Georgia Power focuses on delivering world-class service to its customers every day and the Company is recognized by J.D. Power and Associates as an industry leader in customer satisfaction. For more information, visit www.GeogiaPower.com and connect with the Company on Facebook (Facebook.com/GeorgiaPower), Twitter (Twitter.com/GeorgiaPower) and Instagram (Instagram.com/ga_power). Southern Company (NYSE: SO ) is a leading energy provider serving 9 million customers across the Southeast and beyond through its family of companies. Providing clean, safe, reliable and affordable energy with excellent service is our mission. The company has electric operating companies in three states, natural gas distribution companies in four states, a competitive generation company, a leading distributed energy solutions provider with national capabilities, a fiber optics network and telecommunications services. Through an industry-leading commitment to innovation, resilience and sustainability, we are taking action to meet customers' and communities' needs while advancing our goal of net-zero greenhouse gas emissions by 2050. Our uncompromising values ensure we put the needs of those we serve at the center of everything we do and are the key to our sustained success. We are transforming energy into economic, environmental and social progress for tomorrow. Our corporate culture has been recognized by a variety of organizations, earning the company awards and recognitions that reflect Our Values and dedication to service. To learn more, visit www.southerncompany.com . Southern Company invests in the well-being of its employees and their families through a comprehensive total rewards strategy that includes competitive base salary, annual incentive awards for eligible employees and health, welfare and retirement benefits designed to support physical, financial, and emotional/social well-being. This position may also be eligible for additional compensation, such as an incentive program, with the amount of any bonus/awards subject to the terms and conditions of the applicable incentive plan(s). A summary of the benefits offered for this position can be found here https://seo.nlx.org/southernco/pdf/SOCO-Benefits.pdf . Additional and specific details about total compensation and beneﬁts will also be provided during the hiring process. Southern Company is an equal opportunity employer where an applicant's qualifications are considered without regard to race, color, religion, sex, national origin, age, disability, veteran status, genetic information, sexual orientation, gender identity or expression, or any other basis prohibited by law. Job Identification: 19836 Job Category: Human Resources Job Schedule: Full time Company: Georgia Power

About the Company

Southern Company

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