Lost Time Workers Compensation Claims Adjuster

Workers Compensation Lost Time Adjuster FLSA Status: Exempt Brief Description The purpose of this position is to manage complex workers’ compensation claims where lost wages may be due and determine compensability. This is accomplished by investigating files through a recorded statement, performing interviews, reviewing medical notes, accepting or denying claims, calculating and paying compensation, assigning outside vendors when needed, attending mediations and hearings, monitoring and adjusting reserves on claims, handling and reviewing incoming mail, filing appropriate forms, and acquiring and maintaining adjuster licenses. Other duties include responding to inquiries, visiting members when requested, and coordinating and scheduling department continuing education courses. Essential Functions Manages claims by monitoring and paying medical bills; determining and calculating various types of payment; assigning appropriate vendors; facilitating doctors’ orders; overseeing adequacy of reserves until closure; maintaining computer notes, diary and contact with employer; monitoring incoming correspondence; concluding claims by paying PPD or settling; attending mediations and hearings; reporting per requirements; and requesting settlement authority. Oversees claims investigation by understanding changing case laws, medical terminology, and reports; communicating effectively with members, injured employees, attorneys and vendors; contacting involved parties within 24 hours; and determining compensability claim within 14 days. Performs additional administrative duties by furnishing file material to opposing counsel pursuant to NCIC rules; responding to inquiries; sending medical bills for bill review; requesting bills; and generating correspondence as needed. Oversees education and training by attending seminars and workshops to enhance workers’ compensation ability; maintain CE hours; providing training to members; preparing presentations; mentoring other adjusters; identifying courses or seminars for training; attending courses as directed; and understating policies and procedures, claim handling guidelines and procedures. Job Requirements Experience: One or more years Certification & Other Requirements: North Carolina Adjuster’s License and a Valid Class C Driver’s License #J-18808-Ljbffr The James Allen Companies Inc