Register
Recruit Create CV
Unfortunately, this job posting is expired.
Don't worry, we can still help! Below, please find related information to help you with your job search.
Related keywords
Some similar recruitments
Senior Workers Compensation Claims Specialist I/Ii- Eberle Vivian
Recruited by Liberty Mutual 8 months ago Address , Remote $72,300 - $127,700 a year
(Remote) Claims Team Lead - Workers Compensation
Recruited by Sedgwick 8 months ago Address , Chicago
Workers Compensation Subrogation Specialist
Recruited by EXL Services 8 months ago Address , Remote
Care Coordinator I - Workers' Compensation
Recruited by One Call 8 months ago Address , Remote $16.49 - $18.75 an hour
Compensation Manager Jobs
Recruited by Imagine Learning 8 months ago Address , Remote $74,058 - $100,000 a year
Claims Manager, Workers Compensation
Recruited by Nationwide 8 months ago Address , Remote
Director, Workers Compensation Product Development
Recruited by Farmers Insurance Group 8 months ago Address , Remote
Workers Compensation Tpa Claims Assistant
Recruited by EMC Insurance 8 months ago Address , Remote
Underwriting Product Consultant - Workers' Compensation
Recruited by EMC Insurance 8 months ago Address , Remote
Workers Compensation Underwriter Jobs
Recruited by Engage PEO 9 months ago Address , Remote $70,000 - $100,000 a year
Workers Compensation Claims Representative (Northeast)
Recruited by Berkshire Hathaway Direct Insurance Company 9 months ago Address , Remote
Workers Compensation Claims Adjuster Iii
Recruited by Intercare Holdings Insurance Services 11 months ago Address , Remote $75,000 - $98,000 a year

Workers' Compensation Claims Adjuster - Tpa Oversight

Company

EMC Insurance
Address , Remote
Employment type FULL_TIME
Salary
Expires 2023-07-19
Posted at 11 months ago
Job Description
At EMC, you'll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company's success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees.

**This position is eligible to work from home anywhere in the United States**
Essential Functions:
  • Participates in workers’ compensation projects as assigned by leadership
  • Assists Claims team members as needed, including providing support to providing guidance on claims handling practices
  • Promptly evaluates and reviews Workers’ Compensation claims handled by third party administrator’s (TPA) for adherence to EMC Client Service Instructions
  • Submits referrals to the Special Investigation, Subrogation, Corporate Office Coverage Counsel, Medical Management and Medical Review Units as appropriate
  • Assists with marketing and agency duties as needed for special large account handling for prospective accounts/agencies
  • Provides input to leadership on TPA service, compliance, pricing, and contracts
  • Initiates timely communication with insureds and agents to explain TPA role and explain the claims process
  • Actively participates in claims roundtables by preparing cases needing group discussion and providing input on cases shared by other claims adjusters
  • Identifies potential fraudulent claims and refers cases to Special Investigation Unit (SIU) as appropriate, and participates in any subsequent subrogation and SIU proceedings
  • Recommends appropriate defense counsel firm to TPA
  • Audits TPA benefit calculations due and ensures they are paid appropriately
  • Ensures TPA compliance with all state-specific and jurisdictional reporting requirements through all required communication channels and documents actions appropriately
  • Assists other workers compensation claims professionals with complex or problematic claims as necessary
  • Reviews TPA requests for vendor referrals for reasonableness and ensures ongoing activity for impact to overall outcome of the claim
  • Manages claim recoveries including resolution of financial deviations and subrogation
  • Partners with TPA to resolve questions of coverage, liens, contribution compensability, and the value of claims
  • Issues timely payments within check authority limit
  • Reviews bills, invoices, and receipts, including legal expenses, for accuracy and appropriateness
  • Makes recommendations to people leader on TPA claims handling guidelines. Ensures compliance with EMC TPA claims handling protocols
  • Reviews TPA claim activity and provides direction as appropriate on investigations, follow up, and evaluation of exposure
  • Reconciles TPA claim payments for accuracy and appropriateness
  • Utilizes information gathered to set timely, adequate reserves using reserve worksheets in compliance with the company reserving philosophy and methodology
  • Maintains accurate and timely diaries on all files on an on-going basis Documents claim activities, reserve analysis, and summaries of reports in the claim system
  • Secures all necessary official reports, claim forms, and pertinent documents from TPA as appropriate
  • Conducts regular meetings with TPA partners to discuss trends and claims handling strategies
  • Facilitates return to work strategy with TPA and insured as appropriate
  • Investigates Medicare liens and timely resolves in accordance with EMC and Medicare guidelines, where applicable
  • Prepares risk alerts for Underwriting and Risk Improvement
  • Assists with training less experienced team members
  • Serves as the liaison between EMC agents and insureds to field claim questions, updates and facilitate resolution of any specific concerns including obtaining evidence for the TPA
  • Reviews the claim notices, lawsuits, contracts, and policies to verify coverage and deductibles
  • Markets On Call Nurse (OCN), Return to Work (RTW), and Select Preferred Provider (SPP) programs to insured’s and identifies non-use for corrective measures
  • Reviews TPA settlement evaluations for authority concurrence
  • Identifies, investigates, and proactively pursues opportunities for recovery
  • Communicates with insureds, TPA, and/or attorneys to facilitate settlement of claims
  • Completes detailed file audit prior to closure
  • Participates in scheduled claim reviews
  • Maintains continuing education credits and current licenses as required by jurisdiction
Education & Experience:
  • Relevant insurance designations preferred
  • Bachelor’s degree or equivalent relevant experience
  • Prior experience overseeing claims files processed by a third-party administrator preferred
  • Five years of workers’ compensation claims adjusting experience or related experience
  • Attainment of all applicable state licenses within six months of hire
Knowledge, Skills & Abilities:
  • Ability to adhere to high standards of professional conduct and code of ethics
  • Strong organizational and written and verbal communication skills
  • Excellent knowledge of the theory and practice of the claim function, including third party administration
  • Strong knowledge of computers and claims systems
  • Strong knowledge of insurance contracts, medical terminology and substantive and procedural laws
  • Travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if driving
  • Excellent customer service skills
  • Excellent investigative and problem-solving abilities
**Per the Colorado Equal Pay for Equal Work Act, the hiring range for this position for Colorado-based team members is $82,937.40 - $124,406.10. The hiring range for other locations may vary.**

Our employment practices are in accord with the laws which prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.
All of our locations are tobacco free including in company vehicles.
To learn more about why you’re gonna love it here, watch the video below.