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

VjZ6YXZQREVMejZncU01MTZpMzhPR3BvTXc9PQ==
  • 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,

Similar Jobs

Department of Insurance

SPECIAL INVESTIGATOR Job at Department of Insurance

 ...Job Description and Duties BACKGROUND CHECK ANDFINGERPRINTING ARE REQUIRED. Special Investigators within the Investigation Division are designated under California Penal Code 830.11 as officers of the state authorized to exercise limited peace officer powers,... 

adidas

Forklift Operator (single/double Walkie) Job at adidas

 ...operate any assigned powered industrial trucks (PIT) such as forklifts, stand up order picker/ cherry picker as well as other powered...  ...and stoop, kneel, crouch, and crawl Requisite Education and Experience / Minimum Qualifications: High School diploma or Equivalent... 

Fox Corporation

News Reporter Job at Fox Corporation

 ...stations collectively produce approximately 1,200 hours of local news every week. These stations leverage viewer, distributor and...  ...Live Coverage: Deliver engaging live streaming and linear news reports during breaking news and scheduled newscasts, demonstrating superior... 

LaSalle Network

Digital Experience Designer Job at LaSalle Network

 ...LaSalle Network has partnered with a digital ad agency here in Chicago. Theyare looking to hire a contract Digital Experience Designer . As a Digital Experience Designer , you will define and design digital experiences including websites and apps, including defining... 

Aramark

Retail Supervisor - Powell - Wahweap Marina Job at Aramark

The Retail Supervisor coordinates a team of employees at an assigned location under the direction of the Retail Manager. Responsible for interactions between management, guests, employees, and vendors. Job Responsibilities Supervises the receiving and tagging...