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TPA Claims Specialist II

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General Description: Adjuster of lost and non lost time claims for workers compensation.

Responsibilities:

  • Advanced Knowledge of claims function and processes.
  • Ability to effectively communicate with internal and external customers.
  • Strong understanding of workers compensation or disability claims management, strategies, resolution techniques and adjusting.
  • Technical capability to enter first reports of injury and to adjust lost time and non lost time claims utilizing the features of the TPA claim management systems.
  • Participates in claim advocacy and negotiations, including claim denials, reserving files, and claim reporting, issuing payments, attending hearings, conciliations or mediations and filing of state forms.
  • Determine compensability of the claim as it relates to the worker compensation jurisdiction.
  • Review and approval of loss time, medical services and expenses to be paid of the claims file.
  • Plan and attend claim reviews with clients, carriers and auditors.
  • Ability to identify client issues, build a plan towards resolution, execute and manage internal and external expectations effectively.
  • Analyzes claims based on the TPA best practices as outlined in the "Policy and Procedures" manual. 

Knowledge, Skills and Abilities:

  • Ideal candidate will have a minimum 5 years of claims adjusting experience.
  • College degree preferred but high school diploma or graduate equivalent degree required.
  • Proficient-to-expert in MS Office suite of products.
  • Must be licensed in all jurisdictions handled.
  • Superior written and oral communication skills.
  • Ability to work well in a team environment.
  • Must have strong analytical thinking and problem-solving skills.
  • Strong organizational skills required.
  • Strong negotiation skills required.

Job ID:

17380

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