Claims Adjuster

POSITION SUMMARY:

Independently investigate, evaluate, negotiate, settle and adjust claims in accordance with MD Workers’ Compensation Law and internal Guidelines.

DUTIES AND RESPONSIBILITIES:

• Independently investigates assigned claims, following sound claims handling techniques in accordance with company claim philosophy and quality assurance standards, and in accordance with the Maryland Compensation Law.

• With limited assistance from unit supervisor, review all relevant data, evaluates claims, determine coverage & compensability, set reserves and negotiates settlement within settlement authority.

• Documents files with necessary reports, investigative notes, and other data as may be required by Maryland Workers’ Compensation Law, the company and the unit supervisor. Advise supervisor on status of problematic claims.

• Prepares files for hearing, develops defense of issues, identifies witnesses and makes decisions regarding appeals.

• Attends hearings, mediations, settlement conferences, pre-trial hearings and fraud trials.

• Provide superior customer service to all internal and external stakeholders and the claims public. Complies with standards for service and prompt contact. Keeps agents and policyholders informed of claim status as appropriate. Anticipates and promptly responds to all issues and concerns.

• Manages personal caseload effectively in accordance with claims standards and guidelines and demonstrates the ability to learn, develop and manage complex cases.

• Demonstrates effective understanding of workers’ compensation claim handling to include evaluation and calculation of average weekly wage, disability ratings, reserves.

• Demonstrates an understanding of the impact of Medicare on workers’ compensation claims to include Medicare Set-Asides and Conditional Payments.

• Performs other duties as assigned.

• Pursuit of continued education and professional development of industry knowledge.

• Contributes to the achievement of established department goals and objectives; adheres to departmental policies, procedures, quality and safety standards, and consistently exhibits Chesapeake’s Values and Behaviors.

SKILLS, EDUCATION AND EXPERIENCE:

• Bachelor’s degree and 2–4 years of industry-related experience or 5–8 years equivalent work experience including 3 years of workers’ compensation claims adjusting.

• Attainment of AIC certification or comparable certification in insurance.

• Knowledge of claims basics including administrative procedures and processes, law, reserving, investigation, calculation of benefits, case management, fraud, subrogation, etc.

• Must be a detail-oriented, flexible self-starter, with excellent written and verbal communication skills, capable of handling multiple tasks in a challenging environment.

• Bilingual skills strongly preferred.

POSITIONAL COMPETENCIES:

• Bias for Action

• Deliver Results

• Personal Leadership

• Knowledge Sharing

• Service and Sales Excellence

• Teamwork and Communication

PHYSICAL DEMANDS:

While performing the duties of this job, the teammate is regularly required to sit, use hands and fingers, handle or feel objects, tools or controls; reach with hands and arms. The teammate is occasionally required to stand, walk, stoop, kneel, crouch or crawl. The teammate may occasionally lift up to 30 pounds. Specific vision abilities are required which include close vision, peripheral vision and the ability to adjust focus.

WORK ENVIRONMENT:

Office environment. The noise level is usually moderate.

SALARY:

$64,605-$96,907 (per year, commensurate with experience)

Senior Claims Adjuster

POSITION SUMMARY:

Independently investigate, evaluate, negotiate, settle and adjust claims in accordance with MD Workers’ Compensation Law and internal Guidelines, manage more complex claims and mentor others.

DUTIES AND RESPONSIBILITIES:

• Independently investigates claims, following sound claims handling techniques in accordance with company claim philosophy and quality assurance standards, and in accordance with the Maryland Compensation Law.

• Reviews all relevant data, evaluates claims, determines coverage and compensability and negotiates within settlement authority.

• Documents files with necessary reports, investigative notes, and other data as may be required by the Maryland Workers’ Compensation Law, the company and the unit supervisor. Advise supervisor on status of problematic claims.

• Prepares files for hearing, develops defense of issues, identifies witnesses and makes decisions regarding appeals.

• Attends hearings, mediations, settlement conferences, pre-trial hearings and fraud trials for assigned files, and accompanies less experienced personnel as requested.

• Assists in the training, mentoring and development of less experienced staff and, upon request, assumes supervisory duties in supervisor’s absence.

• Provide superior customer service to all internal and external stakeholders and the claims public. Complies with standards for service and prompt contact. Keeps agents and policyholders informed of claim status as appropriate. Anticipates and promptly responds to all issues and concerns.

• Manages personal caseload independently and effectively in accordance with claims standards and guidelines, demonstrating the ability to handle cases of various levels of complexity.

• Demonstrates effective understanding of workers’ compensation claim handling to include evaluation and calculation of average weekly wage, disability ratings, and reserves.

• Analyze and exhibit a higher level of understanding of claims financial exposure directly impacting the business.

• Demonstrates an understanding of the impact of Medicare on workers’ compensation claims to include Medicare Set-Asides and Conditional Payments.

• Performs other duties as may be dictated by department circumstances.

SKILLS, EDUCATION AND EXPERIENCE:

• Bachelor’s degree and 4-7 years of claims adjusting experience or 10 years equivalent work experience including 5 years of workers’ compensation claims adjusting and AIC designation or comparable designation.

• Basic keyboarding and math skills.

• Bilingual skills preferred.

• Must be a detail-oriented, flexible self-starter, with excellent written and verbal communication skills, capable of handling multiple tasks in a challenging environment.

POSITIONAL COMPETENCIES:

• Customer Experience Management

• Analytical Thinking/Problem Solving

• Communicating Effectively

• Decisiveness

• Drive for Results

• Organizational/Time Management

PHYSICAL DEMANDS:

While performing the duties of this job, the employee is regularly required to sit, use hands and fingers, handle or feel objects, tools or controls; reach with hands and arms. The employee is occasionally required to stand, walk, stoop, kneel, crouch or crawl. The employee may occasionally lift up to 30 pounds. Specific vision abilities are required which include close vision, peripheral vision, and the ability to adjust focus.

WORK ENVIRONMENT:

Office environment. The noise level is usually moderate.

SALARY:

$69,780-$104,670 (per year, commensurate with experience)