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