TPA Workers Compensation Claims Adjuster

Senior Level Lost Time Claim Adjuster For Workers Compensation Locations: MA - Chicopee | Job ID: 32201 Responsibilities Advanced knowledge of claims function and processes. Ability to effectively communicate with internal and external customers. Expert understanding of workers compensation or disability claims management, strategies, resolution techniques and adjusting. Technical/administrative capability to adjust lost time, utilizing the features of the TPA claim management systems. Participates in claim advocacy and negotiations, including claim denials, reserving files, and claim reporting, issuing payments, attending hearings, conciliations or mediations and filing of state forms. Determine compensability of the claim as it relates to the worker compensation jurisdiction. Review and approval of lost time, medical services and expenses to be paid of the claims file. Plan and attend claim reviews with clients, carriers and auditors. Negotiate and recommend claim file settlements to the client. Ability to identify client issues, build a plan towards resolution, execute and manage internal and external expectations effectively. Analyzes claims based on the TPA best practices as outlined in the "Policy and Procedures" manual. Skill set to implement new business with "Special Account Instructions". Understand the financial impact of losses. Ability to communicate with internal resources to explain results and help develop improvement for risk management plans. Ability to develop high quality output documents for internal resources, clients and carriers Understand client business issues. Attend sales presentations. Act as a team leader with the non lost time claim adjuster and the medical case manager. Knowledge, Skills and Abilities Ideal candidate will have a minimum of 10 - 15 years of claims administration experience. College degree preferred but high school diploma or graduate equivalent degree required. Expert in MS Office suite of products, especially MS Excel. Superior written and oral communication skills. Ability to lead a team and work well in a team environment. Must have expert analytical thinking and problem-solving skills. Superior organizational skills required. Expert negotiation skills required. $73-$90k #J-18808-Ljbffr