Sr. Adjuster-Workers Comp Claims

Claims Adjuster Senior, Indemnity

CopperPoint has an exciting opportunity for a fully remote Claims Adjuster Senior, Indemnity. The ideal candidate must possess Texas jurisdiction technical claims knowledge and reside in the state of Texas. Additional knowledge of Oklahoma jurisdiction, as well as surrounding Southwest states is highly preferred. The Claims Adjuster Senior, Indemnity is responsible for analyzing time loss workers' compensation claims to determine compensability. They will also adjudicate claims to ensure timely payment of indemnity and medical benefits due within company standards and in compliance with regulatory requirements, as well as establish and maintain action plans and reserves to ensure proactive, cost-effective claims management.

Job Responsibilities:

• Analyze and investigate indemnity claims to determine compensability decisions by interpreting and applying laws, rules, and regulations of workers' compensation.
• Build and maintain professional relationships with injured workers, policy holders, brokers and agents through proactive claim management and timely communications.
• Appropriately document communications and claim management activities.
• Develop, maintain and adhere to action plans and reserves on indemnity claims while proactively managing claims to resolution.
• Establish and maintain cost drivers and data elements to ensure accurate NCCI and Medicare reporting.
• Proactively manage claims in accordance with company standards and statutory requirements.
• Ensure timely payment of indemnity and medical benefits.
• Actively utilize all available cost containment measures and programs.
• Identify settlement opportunities.
• Negotiate settlements with claimants and attorneys.
• Conducts dispute resolution with claimants and attorneys.
• Testify at hearings when necessary.

Qualifications/Competencies:

• Excellent customer service skills to include initiative, mature judgement and discretion.
• Bachelor's degree (B. S. or B.A.) in business administration, communications, or a related field from an accredited four-year college or university is preferred.
• This is not an entry level position- A minimum of 3 years of direct handling of Texas workers' compensation claims is required.
• Experience in one or more of the other states in our region is preferred (AZ, UT, NV, NM, OK, MO, KS, FL, GA, NC, SC)
• Texas Adjusters license is required.
• Bilingual in Spanish preferred.
• Strong technical claims knowledge with prior successful experience in a workers' compensation as well as other commercial lines claims management environment.
• Knowledge of Department of Insurance (DOI), NCCI, Department of Labor and Employment (CDLE) rules and regulations.
• Ability to analyze, interpret and apply laws, rules and regulations pertaining to workers' compensation.
• Ability to stay current with changes to statutory, industry rules and regulations as well as company policies and procedures which may impact claims management.
• Ability to set priorities, manage time, organize work and meet deadlines.

Benefits: Employees and their families are eligible to participate in CopperPoint Insurance Companies benefit plans including medical, dental, vision, short-term disability, long-term disability, life insurance, a health savings account, a flexible spending account, and a 401k plan. We provide some benefits at no cost to the employee (Basic Life Insurance and AD&D at two times an employee's annual salary, Short- and Long-term Disability coverage, and Employee Assistant Plan). Employees will accrue 0.0769 hours of Paid Time Off (PTO) per paid hour, which may total 20 days a year. In addition, employees will also receive 10 paid holidays throughout the calendar year.

Founded in 1925, CopperPoint Insurance Companies is a leading provider of workers' compensation and commercial insurance solutions. With an expanded Line of insurance products and a growing ten-state footprint in the western United States, CopperPoint embodies stability for policyholders in Alaska, Arizona, California, Colorado, Idaho, Nevada, New Mexico, Oregon, Utah, and Washington. CopperPoint Mutual Insurance Holding Company is the corporate parent of Arizona-based CopperPoint Insurance Companies, Alaska National Insurance Company, and other CopperPoint Insurance Entities. CopperPoint's culture of compassion extends to the community through employee volunteerism, corporate matching, Board service, program sponsorships, and in-kind contributions. We empower employees by providing 12 hours of paid volunteer time annually and matching their personal contributions to the charities of their choice up to $500 per year. In 2020, CopperPoint employees reported 3,500 volunteer hours.