We are currently seeking an experienced multi-line Sr. claims adjuster.
The selected applicant would be responsible to receive and review all new claims and investigate circumstances surrounding employee injuries for compensability, potential liability, denial, subrogation, and fraud issues. They are to make reasonable determinations on each claim based on facts through 4 point contact and industry-standard investigations. Should be able to set reserves for ultimate outcome based on individual claim circumstances and are responsible for all aspects of claims management required by state statute and self-funded plans/policy. This position includes determining compensability; authorizing or denying medical treatment within the parameters of their authority; handling litigation; loss of earning capacity; assigning rehabilitation nurses; private investigators and filing notices with TDI. This position is responsible for calculating indemnity benefits, approving medical bills for payment, and reporting to excess carriers.
Job Knowledge/ Abilities: Excellent customer service skills. Strong verbal and written communication skills. Superior organizational and time management skills. Maintain claim files. Exceptional analytical and problem-solving skills Ability to work and interact with departments throughout the organization and/or autonomously with little supervision.
Education and Experience: 5 years experience as a licensed adjuster. Adjuster license required. Bilingual preferred.
Strong PC skills, including knowledge of Microsoft Outlook, Word, Excel, in this position, you will interact directly with customers and adjusters and be one of the first points of contact for our customers and business associates. You will be required to provide excellent customer service to customers, clients, and all persons contacting the organization.