[Hiring] Claims Adjuster @Cynet Systems

Role Description

The role involves managing workers compensation claims and ensuring proper documentation and communication throughout the process.

• 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, determining benefits due.
• 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.
• Maintains professional client relationships.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Qualifications

• 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.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skill.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Service Expectations.

Requirements

• Workers Compensation Claims Adjudication.
• Subrogation Negotiation.
• Settlement Negotiation.
• Microsoft Office.
• Strong verbal and written communication skills.
• Excellent communication and presentation skills.
• Good interpersonal skills.

Pay Range

$32.85hr - $37.85hr

Qualification And Education

• Bachelor's degree from an accredited college or university preferred.