Workers Compensation - Claims Adjuster

Job Description

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children's Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Position Summary

Under minimal supervision, manages and directs activity of ECU Health workers compensation claims ensuring high-quality results and management of claims in compliance with state laws and company procedures. This position requires considerable interaction on the phone with claimants, doctors, employers, investigators, attorneys with management, other ECU Health staff.

Responsibilities

• Effectively manages a caseload of 150 indemnity workers¿ compensation files, including very complex claims.

• Initiates and conducts investigation in a timely manner based upon state law and best practices for claims handling

• Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines

• Manages medical treatment and medical billing, authorizing as appropriate based on ECU Health claims handling guidelines

• Communicates with claimants, providers and vendors regarding claims issues

• Computes and set reserves based upon ECU Health claims handling guidelines with minimal supervision.

• Negotiates and/or finalize all claims based on settlement authority.

Values and Leadership Competencies

• Maintains diary system for case review and documents file to reflect the status and work being performed on the file.

• Communicates appropriate information promptly to resolve claims efficiently, including any injury trends or other safety related concerns

Minimum Requirements

Requirements

• High School Degree required

• Licensed Claims Adjustor in North Carolina is required

• 3 - 4 years experience as an adjustor

Preferred Requirements

• Bachelors Degree preferred

Other Information

Shift: Monday through Friday from 8am to 5pm

Type: Hybrid

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

Contact Information

For additional information, please contact:

D'metrius Dew, Talent Acquisition Consultant

ECU Health Talent Acquisition

Email: