Maryland Staffing
Claims Examiner
Adecco is currently assisting one of its clients in their search for a Claims Examiner. Pay range: $35 - $40/hr. Shift availability: Remote 8:00 AM - 4:30 PM/Monday - Friday. Duration: 4+ months. To analyze complex or technically difficult workers' compensation claims to find benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Essential Functions and Responsibilities
Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to find the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within designated authority. Calculates and assigns prompt and proper reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes prompt claim payments and adjustments; and settles claims within designated authority level. Prepares necessary state filings within statutory limits. Manages the litigation process; ensures prompt and cost-effective claims resolution. Coordinates vendor referrals for added investigation and/or litigation management. Uses proper cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Reports claims to the excess carrier; responds to requests of directions in a professional and prompt manner. Communicates claim activity and processing with the claimant and the client; keeps professional client relationships. Ensures claim files are properly documented, and claims coding is correct. Refers cases as right to supervisor and management. Additional Functions and Responsibilities
Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. Qualification
Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge
Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills, Strong organizational skills, Good interpersonal skills, Excellent negotiation skills, Ability to work in a team environment, Ability to meet or exceed Service Expectations. Work Environment
When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to manage work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as needed Auditory/Visual: Hearing, vision and talking. NOTE: Credit security clearance, confirmed via a background credit check, is needed for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management keeps the discretion to add or to change the duties of the position at any time. Any specific skill/certification/license: WV and DE or any adjuster license Years of experience: 2-4 years of relevant experience Mandatory: Must have NJ and PA experience.
Adecco is currently assisting one of its clients in their search for a Claims Examiner. Pay range: $35 - $40/hr. Shift availability: Remote 8:00 AM - 4:30 PM/Monday - Friday. Duration: 4+ months. To analyze complex or technically difficult workers' compensation claims to find benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Essential Functions and Responsibilities
Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to find the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within designated authority. Calculates and assigns prompt and proper reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes prompt claim payments and adjustments; and settles claims within designated authority level. Prepares necessary state filings within statutory limits. Manages the litigation process; ensures prompt and cost-effective claims resolution. Coordinates vendor referrals for added investigation and/or litigation management. Uses proper cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Reports claims to the excess carrier; responds to requests of directions in a professional and prompt manner. Communicates claim activity and processing with the claimant and the client; keeps professional client relationships. Ensures claim files are properly documented, and claims coding is correct. Refers cases as right to supervisor and management. Additional Functions and Responsibilities
Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. Qualification
Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge
Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills, Strong organizational skills, Good interpersonal skills, Excellent negotiation skills, Ability to work in a team environment, Ability to meet or exceed Service Expectations. Work Environment
When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to manage work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as needed Auditory/Visual: Hearing, vision and talking. NOTE: Credit security clearance, confirmed via a background credit check, is needed for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management keeps the discretion to add or to change the duties of the position at any time. Any specific skill/certification/license: WV and DE or any adjuster license Years of experience: 2-4 years of relevant experience Mandatory: Must have NJ and PA experience.