Workers Compensation Claims Adjuster

Cross Insurance•New Gloucester, ME

1d•$45,000 - $65,000

About The Position

The Cross Family of Agencies welcomes you. We need your talent and expertise. POSITION: Workers Compensation Claims Adjuster Position Responsibilities Accurate claims adjudication by assessing all information to determine compensability: Effective communication and negotiation skills Creative analytical problem solving skills Ability to manage multiple priorities in a fast paced and dynamic environment Ability to speak and present to various sized groups Interfaces with Self Insured Management Team, claims management division personnel, insureds, health providers and attorneys. Partners with employer in effective claims management. Reviews and authorizes payments. Complies with all state mandated and contractual requirements. Primary Accountabilities: Gains basic knowledge of Department Errors and Omissions Exposures and implementation of Department E&O Procedures. Ensures optimum performance in this function and recommends and implements techniques to increase productivity or department procedures. Develops and maintains an image of corporate excellence and teamwork with emphasis on professional and credible customer service and company relations. Positive and effective co-worker relations: Focus on team goals and objectives Courteous and considerate communications Accurate assistance and support to others as needed.. Position Requirements: High school graduate required; BA/BS degree preferred. Maine Workers' Compensation claim experience or paralegal experience and knowledge of medical terminology preferred. However, we are willing to train the right candidate. Maine Workers’ Compensation license is required by end of first year of employment. Independently manage a caseload of lost time and medical only worker’s compensation claims which are in electronic format. It will involve prompt thorough case investigation to determine compensability, file the required State forms in timely accurate fashion, and develop action plans and reserve projection necessary in order to bring the claims to a conclusion in a timely, cost effective manner in accordance with the Law and our internal policies and procedures. Mathematical/accounting aptitude and excellent analytical, problem-solving abilities required. This work requires prompt accurate wage calculations and ability to calculate proper weekly benefit amounts an injured worker may be due. Self-motivated with ability to work independently but also come together as a team in a fast-paced environment. The successful candidate will have excellent analytical, organizational and problem-solving skills and who is flexible and has the ability to multi task. Excellent communication and interpersonal skills with ability to handle conflict are important. There will be frequent interactions within the organization, our customers, injured workers, lawyers, medical providers and the WCB and handled with tact and diplomacy. Strong computer skills are important. Proficient working in Adobe, Outlook, Excel, Word and not intimidated by learning new programs. Valid driver’s license, reliable transportation and ability to attend offsite meetings as needed. The above describes the primary functions of this position; however, should not be considered a detailed description of all assigned tasks

Requirements

High school graduate required; BA/BS degree preferred.
Maine Workers' Compensation license is required by end of first year of employment.
Mathematical/accounting aptitude and excellent analytical, problem-solving abilities required.
Self-motivated with ability to work independently but also come together as a team in a fast-paced environment.
Excellent analytical, organizational and problem-solving skills and who is flexible and has the ability to multi task.
Excellent communication and interpersonal skills with ability to handle conflict are important.
Strong computer skills are important.
Proficient working in Adobe, Outlook, Excel, Word and not intimidated by learning new programs.
Valid driver’s license
Reliable transportation

Nice To Haves

Maine Workers' Compensation claim experience or paralegal experience and knowledge of medical terminology preferred.

Responsibilities

Accurate claims adjudication by assessing all information to determine compensability
Effective communication and negotiation skills
Creative analytical problem solving skills
Ability to manage multiple priorities in a fast paced and dynamic environment
Ability to speak and present to various sized groups
Interfaces with Self Insured Management Team, claims management division personnel, insureds, health providers and attorneys.
Partners with employer in effective claims management.
Reviews and authorizes payments.
Complies with all state mandated and contractual requirements.
Gains basic knowledge of Department Errors and Omissions Exposures and implementation of Department E&O Procedures.
Ensures optimum performance in this function and recommends and implements techniques to increase productivity or department procedures.
Develops and maintains an image of corporate excellence and teamwork with emphasis on professional and credible customer service and company relations.
Focus on team goals and objectives
Courteous and considerate communications
Accurate assistance and support to others as needed.
Independently manage a caseload of lost time and medical only worker’s compensation claims which are in electronic format.
Prompt thorough case investigation to determine compensability
File the required State forms in timely accurate fashion
Develop action plans and reserve projection necessary in order to bring the claims to a conclusion in a timely, cost effective manner in accordance with the Law and our internal policies and procedures.
Prompt accurate wage calculations and ability to calculate proper weekly benefit amounts an injured worker may be due.
Handle interactions within the organization, our customers, injured workers, lawyers, medical providers and the WCB with tact and diplomacy.
Attend offsite meetings as needed.