Workers Compensation Claims Adjuster - III Professional Search - 5.0 Albuquerque, NM Job Details Temporary | Temp-to-hire | Full-time | Contract $88,000 - $90,000 a year 1 day ago Benefits Health savings account Health insurance Dental insurance 401(k) Flexible spending account Tuition reimbursement Paid time off Family leave Work from home Parental leave Employee assistance program Vision insurance 401(k) matching Employee discount Professional development assistance Flexible schedule Life insurance Referral program Retirement plan Qualifications Computer operation Workers' compensation insurance knowledge Analysis skills 10 key typing Faxing Medical terminology Full Job Description (Hybrid) Workers Compensation Claims Adjuster III - Direct Hire

POSITION SUMMARY

Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. This position requires considerable interaction with clients, claimants on the phone, with management, other Claims Examiners, external business partners and other staff.

DUTIES AND RESPONSIBILITIES

Effectively manages an average caseload of 130 workers' compensation files, including very complex claims.

• Initiates and conducts investigation in a timely manner.
• Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.
• Develops and manages claims through well-developed action plans; continues to work the action plan to stay on task and to bring the claim to an appropriate and timely resolution. Manages medical treatment and medical billing, authorizing as appropriate.
• Calculates and pays benefits due and approves all claim payments. Refers cases to outside defense counsel. Directs and manages as appropriate.
• Manages claim recoveries of all types, including deductible and subrogation. Communicates with clients, claimants, providers and vendors regarding claims issues.
• Computes and set reserves within Company guidelines.
• Settles and/or finalizes 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.
• Adheres to all Company policies and procedures.
• Conducts file reviews independently.
• Other duties as assigned.
• Essential job function.

EQUIPMENT OPERATED/USED

Computer, 10-key, fax machine, copier, printer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING

Appropriate office attire

QUALIFICATIONS REQUIRED

Education/Experience:

4 or more years of experience as a Workers Compensation Claims Adjusting experience with New Mexico Jurisdiction.

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). Knowledge of self-insured claims handling (preferred). City, County and/or District claims handling experience (preferred).

Other Qualifications:

New Mexico Adjuster License Required Pay:

$88,000.00 - $90,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Employee discount Family leave Flexible schedule Flexible spending account Health insurance Health savings account Life insurance Paid time off Parental leave Professional development assistance Referral program Retirement plan Tuition reimbursement Vision insurance Work from home

Experience:

Workers Compensation Claims Adjusting :

3 years (Required)

License/Certification:

New Mexico Adjuster License (Required) Ability to

Commute:

Albuquerque, NM 87110 (Required)

Work Location:

Hybrid remote in Albuquerque, NM 87110