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EMPLOYERS · 12 hours ago

Senior Claims Adjuster I | Florida

United States

Full-time

Remote

Mid, Senior Level

$60K/yr - $90K/yr

7+ years exp

EMPLOYERS is a dynamic provider of workers' compensation insurance and services, seeking a Senior Claims Adjuster I to manage workers' compensation claims in Florida. The role involves handling medical and indemnity benefits, addressing litigation issues, and managing exposure cases with minimal oversight.

FinanceFinancial ServicesInsurance

No H1B

Responsibilities

Completes initial contacts to obtain necessary information, verify coverage, determine compensability and develop a plan of action. Completes and maintains claim data integrity

Independently analyzes case facts to establish timely and accurate reserves using knowledge and experience with medical disabilities and related costs, as well as judgment of extent of disability

Collaborates with Corporate Claims to proactively evaluate and mitigate high exposure losses

Provides timely and appropriate customer service within established best practices. Maintains ongoing professional communications with all internal and external customers

Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines. Files appropriate state forms, as needed

Proactively manages or coordinates medical treatment to continue to move the claim forward. Uses internal and external resources to contain costs and manage exposure

Reviews and analyzes litigation and legal issues. Directs legal strategy and participates in preparation of the case for litigation. Collaborates with defense attorney to move claims to resolution

Completes detailed settlement analysis and recommends appropriate settlement value, utilizing in-depth knowledge of appropriate workers’ compensation insurance principles and laws, subrogation recoveries, offsets and deductions, claim and disability duration, cost containment principles; including medical management practices and Social Security and Medicare application procedure as applicable

Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure. Uses a high degree of independent judgment to render accurate decisions

Mentors other team members and acts as a Subject Matter Expert for legal, jurisdiction and Company needs

Other duties as assigned

Qualification

Florida LicenseWorkers' Compensation LawsClaims ManagementAnalytical SkillsCustomer Service SkillsInsurance DesignationCommunication SkillsProblem Solving SkillsDecision-Making SkillsSelf-Motivated

Required

Must have an active Florida License

7 or more years of related claims experience including complex claim handling. Internal candidates with proven results may also qualify

Superior communication and customer service skills and proficiency in an imaged environment

Demonstrated knowledge of workers' compensation laws and ability to adhere to statutes, regulations and company policies and practices, as well as related claim management procedures/protocols

Self-motivated with the ability to work independently with minimal direction. The ability to multi-task and prioritize, adhere to deadlines and complete assignments accordingly

Excellent analytical, problem solving and decision-making skills

Equivalent combinations of education and experience may be considered