Workers' Compensation Claims Adjuster II

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Requirements:

• Bachelor’s degree or equivalent relevant experience.
• Three years of workers compensation claims adjusting experience or related experience.
• Attainment of all applicable state licenses within six months of hire.
• Relevant insurance designations preferred.
• Strong knowledge of claim functions, insurance contracts, and medical terminology.
• Ability to adhere to high professional conduct standards.
• Strong written and verbal communication skills.
• Excellent customer service skills.
• Solid investigative and problem-solving abilities.
• Strong organizational and empathetic interpersonal skills.
• Valid driver’s license with an acceptable motor vehicle report, if driving is required.

Responsibilities:

• Exercises independent judgment in the investigation, evaluation, negotiation, and disposition of moderately complex workers’ compensation claims.
• Communicates with insureds, agents, and experts regarding coverage and claim status or questions.
• Initiates contact with insureds and injured workers to explain claims process and begin investigations.
• Obtains statements from relevant parties and secures evidence as appropriate.
• Documents all claim activities and activities in the claims system.
• Researches medical treatment and history to understand claims.
• Sets and monitors reserves throughout the claim's life.
• Reviews bills and invoices for accuracy and appropriateness.
• Notifies legally required parties including the state and other carriers.
• Negotiates and resolves claims with insureds and claimants.