Senior Claims Adjuster (Workers Compensation)

Internal Reference Number: R1051054
Summary Description

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose: Independently investigates, evaluates, and negotiates the resolution of assigned claims within approved authority. Responsible for making recommendations for claim outcomes on claims exceeding level of authority.

Logistics: Planned Administrators Inc. (PAI) - one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: This is a full-time position, with a Remote schedule ** , working an 8-hr. shift (40-hours/week) Monday-Friday 8:00am - 5:00pm with primary location at 17 Technology Circle Columbia SC, Columbia, SC 29203. ** Due to initial training period and some on-site activities, qualified, local candidates need apply.

What You'll Do:

• Using advanced subject matter expertise; conduct investigations of assigned claims (workers comp, first and third party property, general liability or auto physical damage) in adherence with corporate timeliness and quality performance standards. Some claims may require in-person investigation/contact with an independent adjusting firm, accident reconstruction by an engineering firm and/or legal research with or without utilization of counsel.

• Manage (catastrophic, high exposure and complexity) caseload to ensure proactive disability, medical management and timely response to treatment recommendations, ongoing contact with the injured and insured, and a 100% closing ratio.

• Provide direction and possible training to less experienced adjustors on less complex cases as needed.

• Document activities, case action plans, settlements evaluations and requests for authorizations in the claim notes. Provide management and internal and external customers with documentation to support recommendations and claim status as required.

• Direct litigation process and work with attorneys to establish defense strategy and case legal budget. negotiate settlements directly with claimants or opposing counsel. May require attendance or testimony at hearings, trials, or mediations. Evaluate specials, damages, and/or extent of disability and negotiate settlements with individuals and/or attorneys.

• Utilize independent adjustors to assist in the evaluation of liability and for damages and reports findings. Reviews independent adjustor's reports and handles claim outcome.

To Qualify for This Position, You'll Need the Following:

• Required Education: Bachelor's degree (see degree equivalency below)

• Degree Equivalency : 4 years job related work experience or Associate's and 2 years job related work experience.

• Required Work Experience: 4 years of area related adjusting experience.

• Required Skills and Abilities: Ability to analyze laws, regulations and contract language. Ability to evaluate issues and develop recommendations. Ability to handle confidential and sensitive information. Ability to investigate assigned claims and propose claims adjustments and refunds. Strong verbal and written communication skills. Strong interpersonal skills.

• Required Software and Other Tools : Microsoft Office.

• Required Licenses and Certificates: Valid adjuster's license in required states or ability to acquire within 6 months-if required by resident state's department of insurance.

We Prefer That You Have the Following:

• Strong organizational skills.

• Solid ability and experience navigating multiple systems.

• Able to work independently.

• Able to manage distractionseffectively.

• Strong communication skills, both verbally and written.

Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage

• 401k retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Education Assistance

• Service Recognition

• National discounts to movies, theaters, zoos, theme parks and more.

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email View email address on click.appcast.io call View phone number on click.appcast.io with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's moreinformation.

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