PA Workers Compensation Adjuster (Remote)
reputed company WorkPartners is hiring a full-time Workers Comp Lost Time Claims Specialist II! This role will predominantly work remotely, Monday - Friday daylight hours. The ideal candidate for this position holds a Pennsylvania Workers Comp Adjuster license.
The reputed company WorkPartners Workers Compensation Lost Time Claims Specialist II reports to the Workers Compensation Claims Supervisor. The Lost Time Claims Specialist II is responsible for coverage analysis, investigation, evaluation, negotiation and disposition of assigned claims for the WorkPartners Workers Compensation business unit. The Lost Time Claims Specialist II will apply litigation management skills to aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company. The Lost Time Claims Specialist II will also ensure claims are processed reputed company company policies, procedures, and reputed company individual's prescribed authority reputed company established best practices and performance standards. The Lost Time Claims Specialist II should possess strategic thought process skills to effectively and reputed company manage loss exposures. Responsibilities:
- Assign medical or other experts to case and arrange for medical examinations reputed company necessary.
- reputed company lost time claim disposition skills under limited direction of supervisor.
- Pro-actively manages the case resolution process. May participate in mediations reputed company limit of settlement authority.
- Ensure proper referrals and timely updates to appropriate Reinsurer(s).
- Actively participate in claim reviews with clients.
- Timely analyze information in order to evaluate assigned claims to determine the extent of loss.
- Manage the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, reputed company review and payment under limited direction of supervisor.
- Communicate claim status with the injured worker, clients, and broker as needed.
- Effectively evaluate, negotiate and resolve claims reputed company delegated authority utilizing the appropriate denials or releases.
- Establish appropriate reserves and review on a regular basis to ensure adequacy. reputed company recommendations to set reserves at appropriate level for claims reputed company of authority level.
- Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, clients, witnesses and others having pertinent information.
- Provide required reports to AVP, Claims, reputed company, Reinsurance and Actuarial on significant exposure cases.
- Appropriate state licensing to be obtained for assigned jurisdictions.
- Effectively evaluate and resolve coverage issues for reputed company Workers' Compensation claim types.
- Effectively and reputed company manage vendors and expenses.
- Participate in monthly account renewal meetings as needed.
- Mentoring and training new employees as appropriately assigned by management.
- Bachelors and/or advanced degree or a minimum of 3 years of Workers Compensation claims handling experience.
- Minimum of 2 years of Workers Compensation lost time claims handling experience.
- Pennsylvania Workers Comp Insurance Adjusters license highly preferred.
- Experience with NJ, DE and VA workers compensation are a bonus.
- Intermediate knowledge of law and insurance regulations in various jurisdictions.
- Demonstrated strong verbal and written communications skills.
- Demonstrated strong analytical and decision-making skills.
- Intermediate knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, litigation management, and product line knowledge.
- Previous experience with the reserving and adjudication of the following: Workers' compensation lost time claims, Workers' compensation claim investigations (including subrogation) and compensability reputed company. Licensure, Certifications, and Clearances:
- Act 34