With Claims Manager guidance, resolves mildly complex Workers'
Compensation claims by investigating, evaluating, documenting and negotiating
settlements within established standards.
Essential Functions and Responsibilities
(Other duties may be
compensation claims by conducting recorded telephone statements of injured
workers, insureds and witnesses and documenting claim files with results.
reviewing the facts of the claims, setting claim reserves, calculating and
paying the appropriate benefits.
review and independent medical examinations (IME) by reviewing the facts of the
claim and posing questions to independent medical personnel and taking the
appropriate action with the results.
and coordinating between involved parties.
guidance by referring claims to attorneys, analyzing state statutes, evaluating
evidence and developing a claim resolution strategy.
Manager guidance by reviewing the facts and determining liability with manager
to communications from: managers, injured workers, injured worker's counsel,
insureds, agents, health care providers, state administrators and others in a
management through Claims Manager guidance by reviewing the severity of the
claim, assigning vendors and directing their activities.
discussions with injured workers and insureds; makes recommendations to manager
regarding reserve changes and future handling of files based on claim facts.
with company procedures and state requirements.
To perform this job successfully, an individual must be
able to perform each essential duty satisfactorily. The requirements listed
below are representative of the knowledge, skills, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.
of workers' compensation adjusting experience involving the exercise of
discretionary decision-making as determined by Society Insurance.
driver's license and a satisfactory driving record as determined by Society
medical terminology and workers' compensation laws and procedures.
equipment (computer, telephone, calculator/adding machine, fax machine,
headsets and copy machines).
Working Conditions and Environment
location, with an office setting, indoor and climate- controlled is typical;
however, outside work is required as well when inspecting losses.
travel and possible overnight stays may be required; unusual work hours may
also be required.
work environment, requiring speed and accuracy.
continuously, light lifting (up to 10 lbs.) occurs frequently and medium
lifting (up to 30 lbs.) occurs occasionally.