Claims Adjuster | Workers' Compensation |

Title: Claims Adjuster | Workers' Compensation

Location: REMOTE (current New Mexico residence)

Innovative employee friendly Claims? Third Party Administrator(TPA) has a brand new opening for a customer centric up and comer dedicated to New Mexico Claims handling MUST be NM residence. File counts are kept to a minimum with helpful Administrative staff and user friendly efficient software systems. Qualified Applicants MUST have recent New Mexico desk experience handling complex litigated Indemnity Claims handling experience and active Adjusters' License. Dedicated to New Mexico Files

General Description

Manage within company standards and best practices complex and problematic high visibility workers' compensation claims within delegated limited authority to determine benefits due, work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer requirements to achieve the best possible outcome in the claim.

Essential Job Duties

Receives claim, confirms policy coverage & acknowledgement of claim

Determine validity & compensability of claim by investigating & gathering info, file necessary documentation with state agencies

Establish reserves & authorize payments within reserving authority limits

Develop and manage well documented action plan with case manager, attorney, supervisor & client to reduce overall cost of claim

Coordinating early return to work efforts with case manager & employer

Negotiates settlements when necessary

Actively manage the litigation process

Identifies potential subrogation claims

Communicate claim status with customer and claimant

Adhere to client guidelines & participate in claim reviews as needed

Develops & maintains professional customer relationships

Education/Training Requirements

Degree at an accredited college or university preferred

Three years handling claims WC Lost Time

Excellent oral, written communication skills & customer service

PC literate, including Microsoft Office (Word, Excel)

Effective analytical & interpretive skills

Strong organizational skills

Great interpersonal skills

Skills: claims, workers compensation, adjuster:

Recruiter Contact [email protected]

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