Skip to content

Third Party Claims Adjuster III

Alternate Locations:

MA - Needham - NEE00

Apply now Share Share Third Party Administration Claims Adjuster III with Facebook Share Third Party Administration Claims Adjuster III with LinkedIn Share Third Party Administration Claims Adjuster III with Twitter Share Third Party Administration Claims Adjuster III with Viadeo Share Third Party Administration Claims Adjuster III with a friend via e-mail

General Description: Senior Level lost time claim adjuster for workers compensation

Responsibilities:

  • Advanced Knowledge of claims function and processes.
  • Ability to effectively communicate with internal and external customers.
  • Expert understanding of workers compensation or disability claims management, strategies, resolution techniques and adjusting.
  • Technical/administrative capability to adjust lost time, 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.
  • Negotiate and recommend claim file settlements to the client.
  • 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.
  • Skill set to implement new business with "Special Account Instructions".
  • Understand the financial impact of losses.
  • Ability to communicate with internal resources to explain results and help develop improvement for risk management plans.
  • Ability to develop high quality output documents for internal resources, clients and carriers
  • Understand client business issues.
  • Attend sales presentations.
  • Act as a team leader with the non lost time claim adjuster and the medical case manager.

Knowledge, Skills and Abilities:

  • Ideal candidate will have a minimum of 10 - 15 years of claims administration experience.
  • College degree preferred but high school diploma or graduate equivalent degree required.
  • Expert in MS Office suite of products, especially MS Excel.
  • Superior written and oral communication skills.
  • Ability to lead a team and work well in a team environment.
  • Must have expert analytical thinking and problem-solving skills.
  • Superior organizational skills required.
  • Expert negotiation skills required.

Job ID:

18756

Interested in hearing about other USI Career Opportunities?

Join Our Talent Network
EEO is The Law - click here for more information
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Notice to 3rd Party Recruiters

Notice to Recruiters and Agencies regarding unsolicited resumes or candidate submissions without prior express written approval.
Resumes submitted or candidates referred to USI Insurance Services by any external recruiter or recruitment agency by any means (including but not limited to via Internet, e-mail, fax, U.S. mail and/or verbal communications) without a properly executed written contract for a specified position by an authorized member of the Talent Acquisition team become the property of USI Insurance Services. The Company will not be responsible for, or owe any fees associated with, referrals of those candidates and/or for submission of any information, including resumes, associated with individuals.

We endeavor to make this site accessible to any and all users. If you would like to contact us, please email recruiting@usi.com