Senior Claims Adjuster (Wine Jobs: Management & Administration)

Full Time

  IPMG (RH Wine & CO., INC.)

  St. Charles, Illinois

JOB SUMMARY 

The Senior Claims Adjuster is responsible for performing technical work on intermediate to complex workers’ compensation lost time and litigated claims; establishing reserves for medical treatment, expenses, and indemnity; and following claims through resolution. This role will operate out of IPMG St. Charles headquarters approximately four days of the week and out of client headquarters in downtown Chicago approximately one day of the week.

ESSENTIAL FUNCTIONS 
  • Coordinate the review, evaluation, and processing of workers’ compensation lost time and litigated claims
  • Analyze first reports to determine the nature of the loss, compensability, and scope of the injury
  • Recognize clients that participate in WCPPP and request/obtain the medical authorizations forms
  • Recognize clients that issue the PEDA benefits and request payments issued to the employee, ensure timely TTD payments are issued, and reimbursements are paid to the client
  • Initiate contact with employers, injured employees, doctors, and other parties to conduct a full investigation
  • Obtain and review medical records and claim-related correspondence and determine appropriate action for each case
  • Establish accurate and timely reserves, both initial and ongoing, to close claims
  • Authorize or deny all payments on the claim file
  • Provide information to clients, claimants, doctors, and others regarding the status of claims
  • Recognize workers’ compensation subrogation opportunities and determine if subrogation should be pursued; when appropriate, collect and review all necessary documentation, contact all appropriate parties, and pursue any third-party recoveries
  • Effectively utilize defense partners and negotiate settlements where appropriate 
  • Work within the assigned authority level
  • Effectively communicate with all internal and external business partners
  • Maintain files notes in accordance with established procedures, timely diary management, and claim closing goals
  • Exercise good judgment in reaching a final disposition of the claim
REQUIRED QUALIFICATIONS  
  •  5+ years of workers’ compensation adjusting experience in Illinois, Michigan, and Minnesota
  • Current adjuster license for Michigan and Minnesota and/or Texas
  • High school diploma or GED, and Bachelor’s degree or equivalent experience
  • Intermediate to advanced level of demonstrated knowledge and skill in claim handling: investigation, written and verbal communication, litigation management, subrogation, medical management, negotiation, reserving, jurisdictional regulations
  • Experience handling intermediate to complex workers’ compensation claims
  • Proven time management skills
  • A detail-oriented and self-directed approach
  • Expertise in Microsoft Office Suite, especially Outlook, Word, and Excel
PREFERRED QUALIFICATIONS 
Previous experience at a Third-Party Administrator  
SCHEDULE
8:30 a.m. to 5:00 p.m. Monday through Friday. Summer hours (Memorial Day to Labor Day) 8:00 a.m. to 5:00 p.m. Monday through Thursday and 8:30 a.m. to 3:00 p.m. Friday.
TRAVEL
Occasional travel to clients for claim reviews is required, in addition to the approximately one day per week worked off-site 

How To Apply

https://workforcenow.adp.com/jobs/apply/posting.html?client=rhwine&jobId=136292&source=IN

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