Workers Compensation Claims Adjuster Job at Brown & Brown Insurance
Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.
Summary:
Manage Workers’ Compensation claims within specific limits and authority.
Essential Duties and Functions: include the following. Other duties may be assigned.
- Investigate and gather information to determine compensability by conducting three point contact interviews with the employer, claimant and healthcare provider.
- Secure and file necessary documents, including FROI & SROI forms with the NYS Workers’ Compensation Board, claimant and claimant’s attorney.
- Establish reserves, authorize payments & treatment within the NYS Medical Treatment Guidelines, under set authority.
- Examine and authorize payment of medical bills.
- Recognize and refer cases when IME’s are indicated.
- Prepare and instruct counsel to defend our interests for hearings at the NYS WC Board.
- Respond to written and telephone inquiries from claimants, clients, attorneys, doctors & vendors.
- Establish proper cost containment techniques; vendor referrals, recoveries & strategic case planning.
- Recognize cases that meet the criteria for reporting to the Excess Carrier.
- Negotiate settlements.
- Control the disposition of the claim process from investigation to settlement.
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Competencies:
- Planning/organizing—the individual prioritizes and plans work activities and uses time efficiently.
- Interpersonal skills—the individual maintains confidentiality, remains open to others' ideas and exhibits willingness to try new things.
- Oral communication—the individual speaks clearly and persuasively in positive or negative situations and demonstrates group presentation skills.
- Written communication—the individual edits work for spelling and grammar, presents numerical data effectively and is able to read and interpret written information.
- Problem solving—the individual identifies and resolves problems in a timely manner, gathers and analyzes information skillfully and maintains confidentiality.
- Quality control—the individual demonstrates accuracy and thoroughness and monitors own work to ensure quality.
- Adaptability—the individual adapts to changes in the work environment, manages competing demands and is able to deal with frequent change, delays or unexpected events.
- Safety and security—the individual observes safety and security procedures and uses equipment and materials properly.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
Required
Exceptional telephone demeanor.
- Ability to maintain a high level of confidentiality.
- Prior experience in adjusting New York State workers’ compensation claims.
- New York State License is required or obtained within 6 months of employment.
Preferred
Bachelor’s degree is preferred.
Physical Requirements Necessary on a Regular Basis:
Manual dexterity, arm and upper body range of motion sufficient for use of a keyboard, mouse and telephone 7-8 hours per day.
Speech and hearing sufficient for in-person and telephone communication 7-8 hours per day.
Vision sufficient for use of a computer monitor.
Ability to sit at a desk 7-8 hours per day.
This job description is not meant to be an all inclusive statement of the duties of the position listed above. Other appropriate duties may be required from time to time.
We are an Equal Opportunity Employer. We take pride in the diversity of our team and seek diversity in our applicants.
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