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Claims Adjuster

Company: SDIC - School Districts Insurance Consortium
Location: Lansdale
Posted on: November 22, 2021

Job Description:

CLAIMS ADJUSTERPOSITION SUMMARY: Independently investigate claim assignments utilizing the SDIC established requirements and policies. Determine strategy and plan of action to minimize exposure on the claim. Conclusions should be made based on all the facts of the claim investigation and applicable rules of law. Establish compensability of the accident and injuries. Determine appropriate reserves, within limits of personal authority, based on the facts of the claim. Render prompt claims service and establish best possible relationship with all persons involved. ESSENTIAL DUTIES AND RESPONSIBILITIES INCLUDE: Checking and maintaining statistical data required of Workers' Compensation claimants. Work involves the on-line entry and retrieval of claimant data information. Must respond to requests for information from claimants, School District administrators and third party administrators. Maintain close attention to accuracy on all levels. Typical examples of work:
1. Investigate all claims with three-point contact. Identify subrogation where appropriate. Maintain files 2. Secure all necessary forms including the employee medical authorization 3. Identify the need for medical management and the use of outside vendors such as defense counsel, surveillance and other field related experts. 4. Payment of compensation benefits and related claim payments within the statutory guidelines of the Workers' compensation Act. As well as SDIC internal policies and procedures. 5. Communicate with our school districts, excess carriers and medical providers on open claims to keep the lines of communication open. 6. Prepare all state forms as required by the Workers' Compensation rules and regulations. 7. Attend continuing education seminars to maintain and improve knowledge of school districts, workers' compensation laws and the medical field. 8. With pre-approval of Claims Manager, negotiates settlements and performs all tasks required to close a case and effect efficient and fair settlement of claims. 9. May assist the executive director, claim manager and controller with special projects or other assigned duties. 10. Prepares all worksheets, state forms, documentation and reporting duties to create a file that is capable of being used by others to monitor progress or continue efficient handling of a claim. SPECIAL RELATIONSHIPS: Claims Adjuster has limited personal authority regarding payment of large medical bills and /or settlements without supervisory review and approval. Must possess good human relation skills to build strong professional relationships with our school districts and our partners in the medical management and legal firms. Claims Adjuster will have frequent contact by telephone with claimants, health care providers, member representatives and the general public. Has interaction with other SDIC personnel. Must be continuously aware of being a team member and an SDIC representative and project a favorable image. Must have the ability to work in conjunction with management and support positions. Continue to work with assigned claim associate in a team-mentoring manner. SPECIFIC JOB KNOWLEDGE, SKILLS AND EXPERIENCE: Must demonstrate a working knowledge of the Workers' Compensation laws, practices and procedures, to efficiently and effectively handle claims to conclusion. Excellent oral and written communication skills, problem solving and analytical skills. Knowledge of the medical and legal terminologies for practical application in the workers' compensation claim. Ability to operate a computer, to communicate effectively both orally and in writing. Develop effective working relationships with superiors, co-workers, claimants and School District administrators. EDUCATION, TRAINING: College degree and advanced training. Minimum of three years claim handling experience. POSITION SCOPE:Reports to: Claims ManagerDepartment: ClaimsPosition Level: Level 12; Full time (office hours currently 8AM-4PM)Location: Lansdale, PAPotential travel: 5% (local)Direct Reports: NoneIndirect Influence: Significant influence on the work of others (4-10 people), both internally and externally.Approval Authority: Significant personal authority with regard to exposure to errors and their impact on the organization.
SDIC offers a competitive compensation and benefits package including paid time off, health/life/disability insurance and pension/deferred compensation plans. The statements contained in this document are intended to describe the general nature and level of work being performed. They are not intended to constitute a comprehensive list of functions and duties. Management retains the discretion to add or to change the duties of the position at any time. SDIC is an Equal Opportunity Employer and a Drug-Free Workplace --- To Apply for this position, please email with a resume and cover letter

Keywords: SDIC - School Districts Insurance Consortium, Philadelphia , Claims Adjuster, Other , Lansdale, Pennsylvania

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