Job Description

Senior Claims Adjuster II (Workers’ Compensation) | 100% Remote Opportunity

Must have experience in one or more of the following states: IL, MO, KS, IN

General Summary:

With minimal oversight, the Senior Claims Adjuster II is responsible for timely and accurate management of workers’ compensation claims with high or catastrophic medical and indemnity benefits, involving litigation and complex issues and exposures.

Essential Duties and 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, serious or catastrophic 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. May handle supervisory duties, as needed.
• Other duties may be assigned.

Job Requirements:

• 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.

• Ten or more years of related claims experience including complex claims handling.

• Must have High School Diploma or GED equivalent.

• If state certification or license is required, must meet certification within state mandated timeframe and maintain any required license through continuing education.

Preferred but not required:

• Bachelor’s degree or equivalent business experience preferred.

• WCCP, AIC, ARM, CPCU or other insurance designation is a plus.

An equivalent combination of education and experience may be substituted for the requirements listed above.

Work Environment/Physical Demands:
This role is 100% REMOTE, and only open to candidates currently located in the United States . It requires a suitable space that provides a private and quiet workplace. This role potentially and will routinely use office equipment such as computers, phones, printers, and web conferencing technology as examples.

• EXPECTED WORK HOURS: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.

• TRAVEL: May be required to travel to off-site location(s) to attend meetings, as necessary

• This is largely a sedentary role; however, some mobility is required
• May work early, late, or occasional weekend hours to accommodate business needs

• Occasional lifting of a maximum of 30lbs.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Salary Range: $70,000- $100,000 and a comprehensive benefits package. Please follow the link to our benefits page for details!

About EMPLOYERS is a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS !

Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees.

We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other!

At EMPLOYERS , you’ll discover an energetic environment that inspires top achievement. As “America’s small business insurance specialist”, we have the resources, a solid reputation, and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote HP22

Compensation details: 70000-100000

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