Workers' Compensation Lost Time Claims Adjuster

Job Description

Job Description

Are you a driven, ambitious, and energetic professional looking for your next challenge? Join Insurance Program Managers Group (IPMG) and become part of a dynamic team committed to innovation! For the past 27 years, our mission has been to create one-of-a-kind solutions for our partners. We bring proactive and tailored approaches to our clients, valuing the unique contribution of each team member. Together, we shape our identity and drive transformative change for our clients.

We are looking for a workers' compensation lost time adjuster. This role is a full-time, exempt position who performs technical work on intermediate to complex workers’ compensation with lost time and litigated claims.

Essential Functions :

• Follows defined processes, quality standards and procedures are followed.
• Ensure contact with insured, claimant, witnesses, doctors and other parties are secured and obtain details about the loss and properly investigate if claims are compensable while using investigative approach in decision making for approval or denial.
• Reviews all new claims within 1-2 business days.
• Reviews claim related correspondences and determine appropriate actions are made.
• Maintains files notes in accordance with established procedures, maintains timely diary management, updates accurate coding and claim closing goals.
• Provides timely and proactive information to clients, claimants, insureds, and others regarding the status of claims.
• Recognizes clients that participate in occupational health structures with compliance to their respective special protocols.
• Sets initial and on-going reserves for incurred costs and authorizes or denies payments based on facts of the claim.
• Ensures subrogation opportunities are consistently identified and executed with correct outline for accurate recovery.
• Draft coverage letters and discuss outcomes with clients and agents proactively before letter is sent.
• Properly evaluate exposure report to excess carriers and reinsurers accordingly
• Roundtable claims with management and counsel, as needed.
• Efficiently manage vendor related costs while assigning the correct vendor based on service need.
• Maintain current weekly diary with limited overdue items
• Where appropriate effectively negotiates using negotiation tactics for settlements
• Executes on 90-day interface claim reviews with quality and timeliness as prescribed by client’s service plan.
• Communicate effectively with all internal and external business partners using all forms of communication to obtain timely contact.
• Written and verbal communication is professional and timely.
• Communicate effectively by expressing oneself in a clear and concise manner in one-one and group discussions while listening attentively in collaborative discussions.
• Foster a sense of energy, urgency, ownership, and personal commitment to work.
• Participation and coordination in client claim reviews and / or teleconferences.
• Occasional travel to clients for claim reviews where warranted.
• Promotes culture of collaboration and teamwork across all organizational boundaries.
• Recognizes clients that participate in occupational health structures with compliance to their respective special protocols.
• Analyzes the nature of the loss, compensability, and scope of the injury for adequate reserving and actions needed to move claim forward.
• Utilizes Nurse Case Management as needed for complex claims
• Works with defense council regarding questionable compensability scenarios and IME doctor selection.
• Maintain Medicare screens to meet Section 111 requirements.
• Ensure qualifying cases have Medicare Set Aside.
• Well versed in multiple jurisdictions.

Non-Essential Functions :

Additional tasks requested by management.

Qualifications :

Compensation and Benefits :

Our Interview Process :

May we suggest you review our website ahead of our contact at www.IPMG.com and check us out on LinkedIn too to see what we are up to lately. Our goal is to meet the real YOU! We want to learn what makes you tick and how you want to grow in your field. And, we will share more about IPMG and answer any of your questions. If we feel we have a match, you will have a chat with our hiring manager to discuss the technical nature of the position to ensure you have the skills needed to be a success.

All About IPMG :

IPMG is committed to a diverse and inclusive workplace. IPMG is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, religion, or other legally protected status.

Candidates that are selected and hired will need to submit to substance, credit, and criminal background screenings, and computer literacy testing.

IPMG is an Equal Opportunity Employer—M / F / D / V.