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Workers' Compensation Adjuster II

Silver SpringErie Insurance




Position Summary

Handles workers' compensation claims within designated authority, exercising discretion and independent judgment in the decision-making process.

This is a remote, work from home role.

Duties and Responsibilities

  • Establishes immediate contact with Policyholders, claimants and medical providers. Contacts Agents as necessary.
  • Handles workers' compensation claims, including fatalities. Investigates compensability and evaluates and makes recommendations regarding coverage of claims. Conducts field investigations as necessary, determines total value of claim, establishes and maintains reserves, manages cases and prepares related reports and correspondence. Investigates and researches statutes for unusual incidents. Maintains all records and related materials.
  • Assigns, monitors and controls activities of vendors in a cost-effective manner.
  • Resolves coverage questions, exercising discretion and independent judgment, and in compliance with applicable workers' compensation law.
  • Evaluates, processes and takes appropriate action on claim-related bills and medical, rehabilitation and special investigative reports. Determines claims to be paid, compromised or contested.
  • Reviews claim files on a regular basis and takes necessary follow-up and/or closing action.
  • Coordinates activities with a rehabilitation specialist on seriously injured claimants and refers special risk situations to commercial underwriting. Notifies company investigative services of cases involving suspected fraud.
  • Participates in informational presentations to Agents and Policyholders.
  • Assists or acts on behalf of the workers' compensation claims supervisor when required.


Competencies

Ability To Learn And Follow Procedures

Ability to Manage Complexity

Decision Making

Detail Orientation

Developing And Maintaining Relationships

Influencing Skills

Information Management Skills

Interpersonal Communication

Job-Specific Knowledge

Planning And Organizing

Problem Analysis

Service Orientation

Time Management

Qualifications

High school diploma or GED required. Bachelor's degree preferred. Five years of previous workers' compensation claims handling experience, including a strong working knowledge of applicable laws required. Working knowledge of medical bill processing required. Successful completion of AIC 37, AIC 44 and medical interpretation courses preferred. Willingness to obtain and maintain any required licenses. Valid driver's license required.

Physical Requirements

Lifting 0-20 lbs; Occasional (<20>
Lifting 20-50 lbs; Occasional (<20>
Lifting Over 50 lbs; Occasional (<20>
Driving; Rarely

Pushing/Pulling; Occasional (<20>
Manual Keying/Data Entry; Often (20-50%)

Climbing; Rarely

Nearest Major Market: Washington DC
Job Segment: Underwriter, Workers Compensation, Adjuster, Claims, Compensation, Insurance, Human Resources

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