Claims Adjuster to manage medical and indemnity benefits associated with injury and occupational disease claims
1. Methodically evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims to their most cost- effective conclusion for Iowa and Indiana claim handling.
2. Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision.
3. Take recorded statements when necessary.
4. Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines.
5. Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels.
6. Establishes and maintains reserve values within authority limits, which accurately predict the loss reflecting the current known circumstances of the claim.
7. Actively develops the investigation of and pursuit of subrogation recoveries when possible.
8. Consults with supervisor or technical support staff on unusually complex claims.
9. Investigates, evaluates and negotiates settlements, applying technical knowledge and human relation skills to effect fair and prompt claim closure and to contribute to a reduced loss ratio.
10. Redirects the claim to the appropriate subject matter expert if the claim becomes significantly complex or presents significantly increasing financial exposure.
11. Applies effective protocols for medical management, litigation, fraud/abuse and recovery.
12. Effectively manages litigation in conjunction with legal counsel.
13. Presents claims and participates in discussion at team staffing.
14. Works collaboratively with injured employee, employer, outside counsel, health and rehabilitation professionals to manage the claims costs, promote quality medical care and timely return-to-work to achieve optimal cost-effective medical and vocational outcomes.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to
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* Must have workers comp claims experience in Iowa and Indiana
* Must have 3 years of experience in the insurance, claims investigation, legal, rehabilitation, or medical claims processing. Workers' compensation claims experience
* Lost time claim handling experience
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.