Senior Claims Adjuster - Workers Compensation

As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.

Responsibilities:

• Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature

• Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)

• Alert Supervisor and Special Investigations Unit to potentially suspect claims

• Ensure timely denial or payment of benefits in accordance with jurisdictional requirements

• Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure

• Negotiate claims settlements with client approval

• Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition

• Work collaboratively with Lodestar nurse professionals to develop and execute return to work strategies

• Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome

• Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced

• Demonstrate technical proficiency through timely, consistent execution of best claim practices

• Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues

• Provide a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions

• Authorize treatment based on the practiced protocols established by statute or the Lodestar Managed Care department

• Assist Lodestar clients by suggesting panel provider information in accordance with applicable state statutes.

• Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.

• #LI-Remote

Qualifications

• MUST RESIDE IN IDAHO

• MUST BE LICENSED TO ADJUST CLAIMS IN IDAHO

• Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry required

• At least 3-5 years' experience handling lost time workers compensation claims required; past experience with ID jurisdiction is required

• Associate in Claims (AIC) Designation or similar professional designation desired.

• Active license required or ability to obtain license within 90 days of employment in mandated states.

• Familiarity with medical terminology and/or Workers' Compensation

• Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously

• Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details

• Strong verbal, written communication skills and customer service skills

• Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.

• Ability to travel for business purposes, approximately less than 10%.