PRIMARY PURPOSE: (Description and Purpose of Position)
Responsible for technical file management of workers’ compensation claims and account management. Requires frequent interaction with the account’s designated contact, case managers, medical providers, claimants and attorneys. Will be required to manage a variety of cases ranging from minimal to high exposures.
DIMENSIONS: (Personnel supervised, Budget responsibility, account size, authority level, etc.)
Manage assigned claims within granted authority level.
- PRINCIPLE RESPONSIBILITIES/DUTIES:
- Client Management
- Participate in policyholder and agency visits assisting with claims training and assistance.
- Analyze and work with Underwriting and Loss Control to develop pro-active plans to correct unfavorable trends with existing policyholders. Report to management, Underwriting and Loss Control unsuccessful attempts to reverse unfavorable actions and adverse conditions.
B. Claims Management
- Investigate all workers' compensation claims assigned by making timely first contacts, and reviewing supporting documents.
- Handle all technical aspects of claims including coverage, disability benefit management, medical management, file management, litigation management, subrogation, reserving and settlement.
- Maintain and demonstrate knowledge of the Workers' Compensation Act and Rules and Regulations in the jurisdictions assigned.
- Immediately notify management of large exposures and comply with reinsurance reporting requirements.
- Monitor expenses and effectiveness of inside/outside vendors.
- Attend mediations.
- Attend client visits and claim reviews.
Must be able to alternate between being seated or standing at desk majority of work time interfacing with keyboard, mouse and typing with intermittent keying of information. Position also involves reading large number of imaged documents, emails, and file notes and talking on the telephone through use of a headset. Adjuster occasionally will walk, stand, bend at the waist, reach out, lift and carry pieces of paper.