Position: Sr. Workers Compensation Claims Adjuster (NM License)Salary: $88,000 to $90,000 (depending on experience)Type: Hybrid (2-days/wk in-office)DUTIES AND RESPONSIBILITIES:
- Effectively manages an average caseload of 130 workers’ compensation files, including very complex claims.*
- Initiates and conducts investigation in a timely manner.*
- Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.*
- Develops and manages claims through well-developed action plans; continues to work the action plan to stay on task and to bring the claim to an appropriate and timely resolution.
- Manages medical treatment and medical billing, authorizing as appropriate.*
- Calculates and pays benefits due and approves all claim payments.
- Refers cases to outside defense counsel. Directs and manages as appropriate.*
- Manages claim recoveries of all types, including deductible and subrogation.
- Communicates with clients, claimants, providers and vendors regarding claims issues.*
- Computes and set reserves within Company guidelines.*
- Settles and/or finalizes 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.*
- Adheres to all Company policies and procedures.*
- Conducts file reviews independently.*
- Other duties as assigned.
* Essential job function.
EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment.
SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire
QUALIFICATIONS REQUIRED:Education/Experience: Bachelor’s degree in related field (preferred); five (5) 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).
- Knowledge of self-insured claims handling (preferred).
- City, County and/or District claims handling experience (preferred).
Other Qualifications:
- New Mexico adjuster’s license required