Claims Adjuster (WC)

Insurance/Medical, Claims, Workers Compensation, Workers Compensation Claims, Medical Management, Medicare, Microsoft Office, Organizational Skills, Presentation Skills, Problem Solving, Quality Program, Security, Coding, Documentation, Medical Claims, Payments, Settlements
Full Time
$60,000 - $65,000
Work from home not available Travel not required

Job Description

One of our clients that is a $2.8 Billion firm and is a leading global provider of technology-enabled risk, benefits and integrated business solutions actively hiring full time Claims Adjuster in St. Louis, MO with experience in Worker Compensation claims handling.

Job Title: Claims Adjuster (WC) Perm

Job Location: St. Louis, MO 63146

Duration: Full Time

Job Description:

Duties:

  • CLAIM YOUR FUTURE AS A GREAT PERFORMER!
  • Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking a place where you can do great things for those whose lives you touch while maximizing your own career possibilities, is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, "Claim Your Future."

Primary Purpose:

  • To analyse mid-and higher-level workers compensation claims to determine benefits due; to ensure on-going adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

Essential Functions and Responsibilities:

  • Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
  • Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
  • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
  • Manages subrogation of claims and negotiates settlements.
  • Communicates claim action with claimant and client.
  • Ensures claim files are properly documented and claims coding is correct.
  • May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
  • Maintains professional client relationships.

Additional Functions and Responsibilities:

  • Performs other duties as assigned.
  • Supports the organization's quality program(s).
  • Travels as required.

Skills & Knowledge:

  • Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Analytical and interpretive skills
  • Strong organizational skills
  • Good interpersonal skills
  • Ability to work in a team environment
  • Ability to meet or exceed Service Expectations

Work Environment:

  • When applicable and appropriate, consideration will be given to reasonable accommodations.
  • Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
  • Physical: Computer keyboarding, travel as required
  • Auditory/Visual: Hearing, vision and talking
  • NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. They are an Equal Opportunity Employer and a Drug-Free Workplace

Education & Licensing:

  • Bachelor's degree from an accredited college or university preferred.
  • Minimum Degree Required: Completed High School (Diploma or GED)

Experience:

  • Four (4) years of claims management experience or equivalent combination of education and experience required.
  • Workers Compensation Claims experience is mandatory
  • Languages: English(Speak, Read, Write)

Skills:

Required:

  • Insurance/Medical
  • Claims
  • Workers Compensation
  • Workers Compensation Claims

Additional:

  • Medical Management
  • Medicare
  • Microsoft Office
  • Organizational Skills
  • Perm
  • Presentation Skills
  • Problem Solving
  • Quality Program
  • Security
  • Coding
  • Documentation
  • Medical Claims
  • Payments
  • Settlements

To discuss further on this opportunity, please connect with Rahil Saiyed @ 847-258-9627 or e-mail him at rahil.saiyed@apideltech.com.

Dice Id : 10509960
Position Id : SED_04
Originally Posted : 3 months ago
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