TITILE: LOST TIME WC ADJUSTER-REMOTE (39785)
TERMS: OPEN CONTRACT
LOCATION: FULLY REMOTE
HOURS: M-F 8-4 OR 9-5
HOURLY RATE: $38.46/HOUR
This position is fully remote and the client would like to have the candidate in the State MA or NC
This role is responsible for the timely, good faith adjustment and disposition of self-administered casualty claims in multiple jurisdictions. Responsibility extends to all aspects and phases of investigations to determine compensability or liability, evaluations, negotiations and settlements/denials of Workers’ Compensation claims. This role has direct responsibility for managing the claim in its entirety while maintaining service and quality level targets.
This role is responsible, specialized technical work investigating and processing claims for self-insured claims programs. This role is the primary claim interface to associates, attorneys, healthcare providers, vendor partners and Brand partnersDuties and Responsibilities: (7-10 bullet points) (Describe, in order of importance, the primary duties and/or responsibilities to be performed, methods used, and why. Statement should include WHAT, HOW, and WHY)Claims Management
- Manage assigned Workers Compensation caseload within established targets and financial authority. Performance standards include thorough investigations, evaluations, negotiation and disposition of all claims, while ensuring that all claims are in compliance with statutory and legal obligations.
- Monitor and ensure timely execution of all statutory deadlines or legal filings as needed.
- Analyze fact of the loss to understand the nature of the claim to develop strategies that provide optimal outcome and mitigate the overall Total Cost of Risk to the Brand bottom lines.
- Identify fraud indicators and actively pursue subrogation opportunities.
- Monitor and actively manage medical treatment with the goal of minimizing disability and fostering a successful re-entry to the workplace.
- Solid understanding of state and federal laws associated with employee relations, including, but not limited to: FMLA, and ADA,
- Closely monitor and manage prescriptions. Work with PBM to authorize prescriptions related to the injury.
- Collaborate with the Safety department in identifying hazards that exist in the retail and distribution operations and ways to minimize these risks.
- Build and maintain effective relationships with internal (Brands, Distributions Centers, Transportation, Ecommerce, Human Resources, Legal, Insurance) and external (vendors, healthcare providers, outside attorneys) customers.
Financial Impact Administration
- Manage book of Workers’ Compensation claims business up to $5 million with authority to settle/negotiate a single claim within their authority of up to $75,000 (Corporate Authority policy)
- Communicate ongoing causes of associate or customer injuries to Safety and Brands.
- Serve as the primary point of contact to address and resolve claim issues impacting associate, vendor, and the Brands. Research and resolve claim/legal issues. Provide timely communication related to the claim, resolving issues, and responding to questions via phone, email, and online applications.
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Qualifications: (List the qualifications needed to perform the role – include education, certifications, knowledge, skills and abilities)
- Licensed adjuster (as appropriate by jurisdiction)
- Bachelor’s degree or 4 years WC claims experience
- Thorough knowledge of rules, regulations, statutes and procedures pertaining to workers' compensation and general liability claims.
- Knowledge of medical terminology involved in complex claims
- Strong negotiation skills.
Our client is looking for a contract adjuster to handle lost time caseload of WC claims (about 100) consisting of a mix of the following states:
DE 21
DC 14
GA 17
IL 12
RI 57
TN 30 (includes MO)
VT 29
WV 12
License required:
Job Type: Contract
Pay: Up to $38.46 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Application Question(s):
- Do you have any of the Adjusters License Connecticut, New Hampshire, New Jersey, Georgia, Virginia, Rhode Island, Delaware, Pennsylvania, Maryland, Maine, Massachusetts, Vermont or New York ?
- This position is fully remote and would like the candidates to live an hour from Quincy MA or Salisbury NC /Do you live in either location?
Experience:
- Workers' compensation: 4 years (Required)
Work Location: Remote