Sr. Work Comp Claims Adjuster (PA & NJ)

Job Title: Sr. Workers Compensation Claims Adjuster POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. DUTIES AND RESPONSIBILITIES: • Adjuster can work from the Philadelphia, PA office or can work remotely from home if approved by hiring manager. • Effectively manages a caseload of 125 to 150 workers’ compensation files, including very complex claims.* • Jurisdiction is PA, NJ* • Initiates and conducts investigation in a timely manner.* • Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.* • Manages medical treatment and medical billing, authorizing as appropriate.* • Refers cases to outside defense counsel. Directs and manages as appropriate.* • Communicates with claimants, providers and vendors regarding claims issues.* • Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Adjuster I and Claims Adjuster II.* • Settles and/or finalize all claims and obtains authority as designated.* • Maintains diary system for case review and documents file to reflect the status and work being performed on the file.* • Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.* • Involves COMPANY loss control staff when appropriate.* • Adheres to all Company policies and procedures.* • Conducts file reviews independently.* • Other duties as assigned. • Essential job function. QUALIFICATIONS REQUIRED: Education/Experience: Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience. Knowledge, Skills and Abilities: • Technical knowledge of statutory regulations and medical terminology. • Analytical skills. • Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff. • Ability to interact with persons at all levels in the business environment. • Ability to independently and effectively manage very complex claims. • Proficient in Word and Excel (preferred). Other Qualifications: • No licenses required for the state of PA or NJ Apply tot his job Apply To this Job