Claims Adjuster - Workers Compensation - Remote / Telecommute

Remote: 
Full Remote
Contract: 
Work from: 

Offer summary

Qualifications:

Bachelor's degree from an accredited college or university preferred., Four years of claims management experience or equivalent education and experience required., Must be licensed and familiar with Client/Client/VA/CT/DE., Strong understanding of workers compensation claims processes..

Key responsabilities:

  • Manage workers compensation claims and determine compensability and benefits.
  • Develop and manage action plans for claims resolution and coordinate return-to-work efforts.
  • Approve and process claims, ensuring proper documentation and coding.
  • Communicate with claimants and clients regarding claim actions and negotiate settlements.

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Cynet Systems Large https://www.cynetsystems.com
1001 - 5000 Employees
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Job description

Job Description:

Responsibilities:
  • Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
  • Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
  • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
  • Manages subrogation of claims and negotiates settlements.
  • Communicates claim action with claimant and client.
  • Ensures claim files are properly documented and claims coding is correct.
  • May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
  • Maintains professional client relationships.
Additional Functions And Responsibilities:
  • Performs other duties as assigned.
  • Supports the organization's quality program(s).
  • Travels as required.
Qualifications Education And Licensing:
  • Bachelor's degree from an accredited college or university preferred.
  • Experience-Four (4) years of claims management experience or equivalent combination of education and experience required.
Requirements:
  • MUST BE LICENSED and familiar with Client/Client/VA/CT/DE.

Required profile

Experience

Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Negotiation
  • Detail Oriented
  • Relationship Management
  • Problem Solving

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