Claims Adjuster - Workers Compensation

Overview

Our Client, a Business Solutions company, is looking for a Claims Adjuster - Workers Compensation for their Remote location.

• 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.
• End-to-end handling of indemnity claims, including initial investigation, compensability determination, and ongoing management.
• Reserving claims for ultimate exposure
• Handling caseload of diaries, correspondence (including email and faxed documentation).
• Jurisdictional Knowledge
• In-depth understanding of PA and NJ workers’ compensation statutes, regulations, and case law.
• Familiarity with state-specific forms (e.g., LIBC forms for PA, WC forms for NJ).
• EDI filing and clearing of errors.
• Wage Loss & Benefit Calculation
• Accurate calculation of Average Weekly Wage (AWW) and Temporary Total Disability (TTD) benefits.
• Application of PA’s 7-day waiting period and NJ’s 7-day retroactive rules.
• Medical Management
• Coordination of treatment plans, utilization review, and compliance with state medical fee schedules.
• Familiarity with NJ’s authorized provider rules and PA’s panel provider requirements.
• Litigation handling
• Managing claims in litigation, including working with defense counsel, attending hearings, and preparing testimony.
• Understanding of PA’s Supersede as process and NJ’s informal/formal hearing procedures.
• Return-to-Work Coordination
• Developing modified duty programs and collaborating with employers to facilitate early return-to-work.
• Communication & Documentation
• Regular interaction with injured workers, employers, medical providers, and attorneys.
• Clear and timely documentation of all claim activities.
• Superior customer service and phone etiquette

• Experience negotiating lump-sum settlements and Section 32 agreements (NJ) or Compromise & Release (PA).
• Drafting settlement evaluations and experience working with Medicare requirements

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or expression, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.