Job Description
job summary:
The Senior Workers' Compensation Adjuster is responsible for the independent planning, scheduling, investigation, and analysis required to process and adjust complex Workers' Compensation claims with minimal input from supervision. The role requires expertise to ensure proper guidelines and regulatory compliance are followed to mitigate financial exposure on high-severity, complicated, or litigated files.
location: Irving, Texas
job type: Permanent
salary: $90,000 - 100,000 per year
work hours: 8am to 5pm
education: High School
responsibilities:
Job Responsibilities Essential Duties and Responsibilities Claim Management & Investigation: Handle the day-to-day management of all Workers' Compensation claims, including complex cases, claims from the date of injury, controverted claims, and pension claims, in accordance with established claim guidelines and state regulations. Coverage and Compensability: Investigate losses and determine or deny coverage and compensability through contact with the claimant, insured, and other involved parties. Reserve Authority: Establish and maintain appropriate case reserves for each claim based on case specifics and company guidelines to accurately reflect the financial exposure. Settlement and Litigation: Manage files in litigation and coordinate with defense counsel. Negotiate claims for settlement within assigned authority levels. Benefits Administration: Review and make appropriate decisions regarding medical bills, wage claims, temporary and permanent disability, and death benefits. Vendor and Referral Management: Refer files to appropriate parties for medical management or special investigative needs, and monitor the status of work performed. Consult with and monitor service providers such as legal counsel, medical, and vocational professionals. Compliance and Reporting: Ensure compliance with procedural guidelines for all reports (diary, EDI, excess, review reports). Stay apprised of current law changes and court rulings affecting claim handling. Risk Mitigation: Identify potential subrogation opportunities and refer them to the appropriate external or internal parties.
qualifications:
This role will handle Workers' Compensation claims.
They will require jurisdictional expertise with Arizona claims. They must be certified.
The other states that the desk will handle is UT, TX, and CO with strong litigation skills.
It would be helpful if they knew Guidewire (Claims Center).
We are looking for someone that can sit hybrid in one of our offices.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad Digital, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact
[email protected].
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad Digital offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
Job Tags
Permanent employment, Temporary work, Work experience placement