WC Adjuster IV
Location: Alexandria, Louisiana
Description: Avizent is looking of WC Adjuster IV right now, this job will be placed in Louisiana. Further informations about this job opportunity please give attention to these descriptions. To provide technical support, claim services and products for customers. Will ensure that production and quality control standards set by the company are met on a daily basis. Responsible for monitoring the assigned claim files and ensure that service standards and quality control standards set by the company are met. Perform all aspects of the job in an accurate and highly motivated fashion.
ESSENTIAL DUTIES & RESPONSIBILITIES
- Investigate, manage, and resolve claims of all values. Most claims will be indemnity claims with complexity and severity issues.
- Manage and direct all aspects of insurance claims litigation.
- Must possess a thorough understanding of all products and services. Understand the impact/relationship these products have on the team and technological support system. As such, must be able to provide technical expertise relative to system, legal, and compliance issues as they arise.
- Determine liability and total value of the claims.
- Negotiate the settlement of claims with clients.
- Monitor regulatory compliance to ensure such requirements are met within defined parameters.
- Have a thorough understanding of all legislative requirements and is able to effectively interpret those requirements in a prudent business manner.
- Make recommendations regarding hearings or litigation of claims
- Maintains a license for all states and products serviced.
- Organize and update all reference material to reflect current legislation and regulatory compliance.
- Comply with all quality control standards set by the company for the handling of claims. Comply with all procedures set forth by the company for performing the job as it relates to the various components of claim administrative services.
- Immediately notify Management of any unusual lawyer inquiries, insurance carrier inquiries, or department of insurance inquiries.
- Have a thorough understanding of all E & O liabilities and keep current and accurate documentation to support claims paying practices and decision-making authorities.
- Understand all facets of system automation.
- Understand the operation of a personal computer and take the appropriate steps to expand current understanding of the technology available as a means to increase personal and operational efficiencies.
- A thorough understanding of managed care products and services, and understand the impact such products have on claim administration and individual claim filing handling. Able to effectively interface with service vendors, claimants, and providers to successfully resolve open issues and bring resolution to the claim file.
- The goal is to maintain the minimum monthly corporate standard average pending file count.
- Monitor workload closely and take appropriate measures to ensure claim files are closed within parameters set by the company.
- Utilize the technology available to effectively support their workload and eliminate manual processing of claim administration.
- Assist with the identification and correction of problems and errors. Provide ideas and suggestions, which increase the quality of products.
- Be aware of the quality control standards set by the company and take positive steps to ensure that performance and products produced meet these standards.
- Ensure that all correspondence, regulatory filings and internal documents are free of error.
- Provide excellent telephone services to claimants, clients, contacts, and outside vendors. On an ongoing basis, improve service knowledge and recognize the importance of providing superior customer service to our customers.
- Ensure that all inquiries are responded to in a timely manner. Demonstrate good written and oral communication skills.
- Provide ongoing feedback to the team leader on issues and concerns impacting our customers and recommend corrective action whenever deemed appropriate.
- Calculate the full and average weekly wage and issue compensation payments according to State WC guidelines.
- High School Diploma or equivalent required. College degree preferred.
- A minimum of 7+ years experience in workersÂ' compensation or general liability field in a claims department or related risk management position is preferred.
- Must have technical and operational knowledge of the legislation, regulation, and compliance requirements of the industry.
- Technical knowledge of medical terminology, procedures, systems and their impact on claim handling is required.
- An ability to interface with attorneys, hearing board members, state regulatory agencies, and customers is an important part of this job.
- Previous supervisory or mentoring skills needed. Will be considered a Â"go toÂ" person for other claims staff in the region. May be asked to train new associates.
- Must also be able to interpret state and federal law in addition to contracts and policies.
- Must make independent claims handling decisions on claims assigned.
- Capable to set and make decisions on reserve levels.
- Able to maintain patience and professional demeanor working with difficult or sensitive situations and people.
- Consistent attention to detail and data resolution.
- Communicate effectively and professionally in writing, by telephone, or in person. Communication effectiveness is demonstrated by conveying necessary information accurately, listening effectively and asking questions when clarification is needed.
- Strong proficiency in keyboarding and data entry skills.
- Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
- Must be able to foster and maintain positive internal and external customer service relationships.
- Must be able to be depended upon to plan and organize work effectively and ensure its completion.
- Must be able to demonstrate reliability by arriving to work on time and taking breaks in expected time frames.
- Will be expected to meet all productivity and quality requirements.
- Must be able to demonstrate team behavior and must be willing to promote a team-oriented environment.
- Must be able to demonstrate initiative, strives to continually improve processes and relationships.
- Highly effective in working objectively with a diverse group of people and must demonstrate communication, organizational, administrative and office skills.
- Must be a team player willing to accept and promote organizational goals and function with minimal supervision.
- The ability to organize and manage multiple priorities.
- Must be able to type accurately, enter information into a computerized system, and operate a ten-key adding machine. Prior computer/PC experience using other word processing, spreadsheets, and computerized billing systems is required.
- Excellent customer service skills (friendly, courteous and helpful)
- Must have a strong desire for professional growth.
- Expected to represent the organization professionally at all times.
- Will exercise necessary cost control measures.
- Strong desire for growth.
- Other duties as assigned.
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If you were eligible to this job, please deliver us your resume, with salary requirements and a resume to Avizent.
Interested on this job, just click on the Apply button, you will be redirected to the official website
This job starts available on: Sat, 07 Jul 2012 11:19:42 GMT