Claims Adjuster

About us

Our Mission is to Continuously improving the economics, quality, safety and outcomes for our Members’ insurance requirements ..

Our Organizational Values:

• Act with integrity
• Be accountable to the Membership and each other
• Communicate with transparency
• Operate with humility
• Give back to our communities
• Share in the fun
• Growth opportunities

Title: Workers’ Compensation Claims Adjuster (Longshore)

Location: Primarily Remote, based inHouston or New Orleans area

Position Type: Full Time, Exempt

Travel Requirements: Up to 10% domestic travel annually and 30% local travel monthly

Job Summary

The Claims Adjuster will investigate, evaluate, dispose, and settle workers’ compensation claims and highest exposures in an autonomous environment. This includes the investigation, determination and evaluation of coverage, compensability, and reserving.

Who is the Ideal Candidate?

The ideal candidate for this role should have a familiarity with standard concepts, practices, and procedures within the claims management field. They should possess the experience and judgment to interpret policies and procedures as established by senior management. This person should feel comfortable working autonomously and empowered to make decisions on goal planning. They should have the ability to understand written and oral communication and to interpret documents, such as workers’ compensation regulations and workers’ compensation forms, medical records, and legal reports.

Essential Duties & Responsibilities

· Exercise proper judgment and decision making to analyze the claims exposure, determine the proper course of action, and to appropriately resolve the claim.

· Interact extensively with various parties involved in the claims process.

· Able to clearly communicate concise action plans for moving claims to conclusion.

· Demonstrate complete knowledge of handling claims arising under the federal workers’ compensation system.

· Process claims consistent with clients’ and corporate policies, procedures, and best practices and in accordance with statutory, regulatory, and ethical requirements.

· Demonstrate the ability to comply with carrier reporting and threshold requirements.

· Able to maintain a timely diary and handle a full caseload, with proven ability to handle cases of increased severity.

· Meet with Members in the local area to ensure claim operational excellence and high Member engagement.

· Serve as contact for 24-hour emergency on-call coverage, as assigned.

· Perform other duties as required or directed.

Core Competencies

· Proficiency in a variety of claims management concepts and practices and have knowledge of general insurance procedures and workers’ compensation benefits preferably under the Longshore and Harbor Workers Compensation Act

· Excellent time management and organizational skills and the ability to multitask.

· Strong interpersonal skills and work co-operatively with others to achieve a common goal.

· Must be comfortable making timely decisions and exhibit sound and accurate judgement.

· Knowledge of Claims Management Systems and Microsoft Office Suite

Education

· Bachelor’s degree preferred or relevant work experience.

· Minimum 3 to 5 years related claims experience, Longshore experience preferred.

Job Type: Full-time

Pay: From $80,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Family leave
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Parental leave
• Professional development assistance
• Referral program
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Travel requirement:

• Up to 25% travel

Work setting:

• Remote

Application Question(s):

• How many years do you have in handling claims?

Experience:

• Workers' compensation: 3 years (Required)

Willingness to travel:

• 25% (Required)

Work Location: Remote