TPA Claims Specialist II - Workers Compensation Adjuster

USI Glastonbury , CT 06033

Posted 3 months ago

General Description: Seeking Workers Compensation Adjuster to handle claims out of our Glastonbury, CT office. The ideal candidate will have an active CT adjusters license and be well versed handling Lost Time Claims from inception to close.

Responsibilities:

  • Advanced Knowledge of claims function and processes.

  • Ability to effectively communicate with internal and external customers.

  • Strong understanding of workers compensation claims, strategies, resolution techniques and adjusting.

  • Technical capability to enter first reports of injury and to adjust lost time and non lost time claims utilizing the features of the TPA claim management systems.

  • Participates in claim advocacy and negotiations, including claim denials, reserving files, and claim reporting, issuing payments, attending hearings, conciliations or mediations and filing of state forms.

  • Determine compensability of the claim as it relates to the worker compensation jurisdiction.

  • Review and approval of loss time, medical services and expenses to be paid of the claims file.

  • Plan and attend claim reviews with clients, carriers and auditors.

  • Ability to identify client issues, build a plan towards resolution, execute and manage internal and external expectations effectively.

  • Analyzes claims based on the TPA best practices as outlined in the "Policy and Procedures" manual.

Knowledge, Skills and Abilities:

  • At least 3 or more years experience handling lost time workers compensation claims.

  • Active CT Adjuster License

  • Previous experience working directly for an Insurance Carrier or TPA.

  • College degree preferred but high school diploma or graduate equivalent degree required.

  • Proficient-to-expert in MS Office suite of products.

#LI-DM2

#GLDR

Job ID:
17380


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TPA Claims Specialist II - Workers Compensation Adjuster

USI