Investigates claims to determine an injured worker’s entitlement to Workers’ Compensation benefits; Administers indemnity and medical benefits for valid Workers’ Compensation claims; manages a caseload of claims from inception to closing or settlement.
ESSENTIAL JOB RESPONSIBILITIES:
- Completes 3-point contact on new claims within 24 hours in order to obtain information necessary to make a compensability decision on the claim
- Establishes appropriate reserve levels based on financial exposure and updates reserves upon receipt of new information
- Directs assistant to properly pay indemnity benefits and Awards. Issue state-mandated benefit notices within the required timeframes
- Annotates, categorizes and addresses incoming mail on a daily basis
- Responds to questions and requests from the client
- Strong proficiency in keyboarding and data entry skills; most time spent in front of a computer entering text with applications.
- Must be able to type accurately, enter information into a computerized system
- This position reports to the Unit Manager
OPS RACI RESPONSIBILITIES:
- Three-point Contact
- Benefit Delivery
- CMR Compliance
- Diary Compliance
- Excess Reporting Compliance
- Closing Ratio/Inventory Reduction
- Significant Claims Activities
- Regular File Reviews
- Statutory Requirements
- Client Relations
- Continuous Improvement
- Client Training
OPS RACI ACCOUNTABILITIES:
- BS / BA or Equivalent Work Experience
- Ability to prioritize multiple tasks and meet deadlines
- Excellent written and verbal skills
- Excellent customer service skills
- Workers’ Compensation law, policies and procedures
- Medical and legal terminology
- Integration with Medicare
Dear Mr. Holloway,
I am writing to apply for the Insurance Claims Adjuster position with United Insurance. I am a professional with an Associate’s degree in Business Management and three years of experience in the insurance industry. In my current job as Insurance Claims Adjuster with Zion Auto Home and Life I take customer calls about claims related to their various policies analyze claim information conduct investigations when needed write incident reports and issue claims decisions.
I pay specific attention to every detail and am able to spot inconsistencies or patterns in accounts easily. My critical thinking and communication skills are sharp which help me to calm agitated clients while making informed decisions relating to their case. With three years in this business I feel I have a thorough understanding of the working of insurance claims. Clients have thanked me numerous times for making their experience as easy as possible and supervisors have given me accolades for my efficiency. I would love to bring my professionalism to the claims department of United Insurance as an Insurance Claims Adjuster.
I am quite sure you will find me to be a candidate worthy of the Insurance Claims Adjuster title. Please contact me soon to schedule an interview. I hope to hear from you and thank you for your consideration.