The Workers Comp Adjuster coordinates the administration of the workers'' compensation program. Responsibilities include claims monitoring and administration, report generation, and communication with employees, managers, insurance carriers, medical personnel and lawyers. Familiar with standard concepts, practices, and procedures within a particular field. Relies on education and training to complete responsibilities. Initially requires instruction and guidance to accomplish job which should develop into working under general supervision.
Bachelor''s degree or equivalent years in healthcare of legal environment
Excellent oral/written communication skills, ability to problem solve and set priorities in a face paced environment
Claims Management
Directs & manages investigative activities related to w/c claims. Maintains contact with injured employee and physicians in an effort to assess continued necessity of treatment related to the claim
Ensures that all activities are accurately and timely posted in the databases
Manages cases to ensure good, timely care in a cost-effective manner.
Calculates applicable payroll, sets reserves on claims, and processes payments in timely manner.
Supervision
Provides supervision to all w/c claimants who are away from work and on modified duty assignments
Works with hospital managers to provide suitable modified duty assignments for claimants
Works with hospital managers and HR to counsel employees who do not follow hospital procedures
Litigation and Reporting
Represents hospital in mediation and trials
Reviews cases for qualification under Second Injury Fund
Prepares & maintains accurate OSHA logs, LA report of annual w/c costs, and other reports as required
Prepares reports of incidents/claims for distribution to hospital management
Claims Management
Directs & manages investigative activities related to w/c claims. Maintains contact with injured employee and physicians in an effort to assess continued necessity of treatment related to the claim
Ensures that all activities are accurately and timely posted in the databases
Manages cases to ensure good, timely care in a cost-effective manner.
Calculates applicable payroll, sets reserves on claims, and processes payments in timely manner.
Supervision
Provides supervision to all w/c claimants who are away from work and on modified duty assignments
Works with hospital managers to provide suitable modified duty assignments for claimants
Works with hospital managers and HR to counsel employees who do not follow hospital procedures
Litigation and Reporting
Represents hospital in mediation and trials
Reviews cases for qualification under Second Injury Fund
Prepares & maintains accurate OSHA logs, LA report of annual w/c costs, and other reports as required
Prepares reports of incidents/claims for distribution to hospital management