Hybrid Senior Workers Compensation Claims Adjuster

at Kansas Builders Insurance Group

• Job title: Senior Workers Compensation Claims Adjuster
• Job type: Full Time
• Experience level: Senior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Atlanta, United States

About the role

• Senior Claims Adjuster analyzing and managing workers' compensation claims at Builders Insurance Group. Ensuring fair resolutions while maintaining compliance in a dynamic business environment.

Responsibilities

• Manage a caseload of limited coverage and medium to severe claims with authorization to resolve cases within a designated monetary threshold.
• Develop and implement impactful strategies to negotiate and resolve claims within established parameters.
• Strive to achieve fair and equitable outcomes while steadfastly upholding company and departmental protocols and standards.
• Deliver quality customer service to all parties involved in the claim process, ensuring prompt and efficient delivery of appropriate benefits.
• Actively participate in meetings or visits with agents, insurers, and policyholders to cultivate professional relationships and facilitate effective issue resolution.
• Conduct investigations into losses utilizing various techniques such as interviews, recorded statements, and thorough documentation.
• Diligently gather and preserve evidence.
• Identify opportunities for subrogation or instances of potential fraud.
• Verify, analyze, and apply coverage correctly to each case based on a thorough analysis of facts and pertinent statutory case law.
• Scrutinize bills, determine necessary actions, and process claims accordingly, prioritizing cost-effective resolutions.
• Prepare concise and timely reports to facilitate efficient claims processing.
• Keep agents, insurers, agency operations, and the corporate Claims Department informed of file status and pertinent developments.
• Ensure accurate and timely filing of all state forms required for claims processing; prepare necessary reports for large loss and reinsurance carriers.
• Establish reserves and authorize payments in alignment with established procedures.
• Scrutinize contracts to evaluate risk transfer and assess duty to defend and indemnify additional insured parties.
• Manage the litigation process in an efficient and effective manner.
• Determine the necessity for, and provide guidance to defense counsel, independent adjusters, or technical experts, while monitoring and managing their expenses.
• Attend hearings, pre-trial settlements, conferences and trials.
• Assess the need for independent medical evaluations, second opinions, nurse or physician reviews, and make referrals.
• Evaluate the need for external services such as surveillance, field adjusters, or field case managers or coordinating referrals.
• Maintain detailed documentation of claims activity in claim notes, regularly reviewing and updating diaries and claim notes for all open claims.
• Meet or exceed expected quality performance guidelines to uphold service standards.
• Participate in professional development through training programs to stay updated on workers’ compensation laws, rules, and regulations.
• Identify cases necessitating large loss and/or reinsurance reports, ensuring comprehensive management.
• Conduct thorough file reviews at various stages of the claims process.
• Contribute to the training of workers’ compensation claim staff under the guidance of management.
• Serve as a technical expert and offer support to management.
• Monitor litigated files to ensure adherence to litigation management protocols.
• Utilize Insurance Service Office (ISO) decision net and claim search inquiries.
• Respond to complaint calls and other inquiries, excluding those related to Department of Insurance (DOI) complaints, with professionalism and efficiency.
• Performs other duties as assigned.

Requirements

• Bachelor's degree or equivalent combination of education and/or experience in the insurance field
• Five or more years of workers’ compensation experience including complex case processing
• Licensed in multiple jurisdictions with a professional claims designation
• Knowledge of applicable state laws across territories of operation
• Knowledge of claims policy, procedures, fiduciary guidelines and best practices
• Skill in interpersonal interactions, with the ability to collaborate effectively with individuals at all organizational levels and with external stakeholders; skill in customer service, problem-solving time management and conflict resolution
• Capacity to work autonomously while ensuring transparent communication with internal leadership
• Skill in planning, time and organizational management; ability to multi-task effectively while paying attention to detail
• Proficient in both verbal and written communication with the ability and commitment to maintain confidentiality
• Proficient with Microsoft Office Suite and function specific software applications

Benefits

• Competitive Salary
• Bonus Structure
• Profit Sharing
• Medical, Dental, Vision Insurance
• Employer Paid Short Term Disability
• Employer Paid Long Term Disability
• Employer Paid Life Insurance
• Voluntary Life Insurance
• 401K with Company Match
• PTO