WC Adjuster (Claims Adjuster Sr Assoc) Qual-Lynx

Investigates, evaluates, disposes of and resolves the most complex claims and highest exposure with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damage, and the setting of proper reserves in a timely manner in accordance with legal statutes, policy provisions and company guidelines.
Review, investigate and analyze Workers' Compensation claims.
Interact with injured employees to ensure awareness and understanding of the Workers' Compensation process, requirements and entitlements.
Manage potentially high exposure and complex claims.
Establish claim reserve levels by estimating the cost of each assigned claim; monitor reserves and update amounts as necessary.
Manage diary and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
Close all files as appropriate in a timely and complete manner.
Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees' medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable.
Identify subrogation potential and pursue the process of reimbursement.
Communicate with defense attorneys regarding litigated cases; make recommendations regarding proposed strategies for claim resolution. Extend bona fide offers, where warranted.
Analyze, compute and process indemnity payments for all appropriate benefits due, including TTD (temporary total disability) PPD (permanent partial disability) and PTD (permanent total disability).
Identify all potential liens and credits available and apply them as appropriate.
Attend and participate in staff meetings and keep supervisor informed of status on all assigned cases and plan of action. Stay abreast of new trends, pending legislation and case law related to workers' compensation.
Process PARs (payment authority request) when applicable.
Assign to the field investigator for GOTCHA visitation within the account specific timeframe.
Manage self-insured retention excess reporting.
Routinely interact with clients, claimants, attorneys, investigators, experts and other vendors. Attent client meetings and present PARS.Requirements include:
Bachelor's degree preferred, HS Diploma required
At least 2 years of experience New Jersey lost time workers' compensation claims required
Knowledge of client and carrier claims procedures required
Understanding of self-insured retention excess reporting strongly preferred
Proficiency with claims related software (iVOS a plus)
Strong proficiency in MS Word and Excel required
Excellent verbal and written communication skills required
Ability to multi-task and work manage multiple priorities
Strong negotiation skills preferred
Excellent organizational skills required
Customer Focus orientation required
Strong analytical skills required

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