We are on the lookout for an experienced Workers' Compensation Adjuster to join our clients team. You will be responsible for investigating and evaluating losses while developing a plan of action to bring claims to proper resolution in a timely manner.
This role does require you to live in New Mexico and have New Mexico adjuster license, with a minimum of 5-7 years of experience handling Workers' Compensation claims.
Key Responsibilities
- Determines extent of insurance coverage and compensability on each filed claim
- Investigates claims, including interviewing employees, employers and witnesses
- Obtains necessary records, including but not limited to, hospital records, police reports, physician records, etc.
- EDI and CMS/Section 111 reporting
- Utilizes appropriate preferred vendors
- Presents thorough and accurate reports to client and/or carrier on claims investigations/situations
- Negotiates settlements for resolutions with claimants and their attorneys
- Maintains control of litigation activities and costs per account requirements
- May be asked to mentor, train and/or share expertise with other Davies staff
- Attends meetings; conferences; workshops or training sessions; and reviews written material to maintain current knowledge on principles, practices and new developments in assigned work areas
- Maintains and meets specific licensing requirements
- Responds to client questions and comments in a courteous and timely manner
- Is responsible for catastrophic losses, complex litigation, and other sensitive issues
- All other duties as assigned
Skills, knowledge & expertise
- Ability to understand and follow oral and/or written policies, procedures and instructions
- Ability to perform a wide variety of duties and responsibilities with accuracy and speed, while meeting time-sensitive deadlines
- Ability to conduct investigations in multi-party situations
- Ability to use standard or customized software applications appropriate to assigned tasks
- Ability to prepare and present accurate, reliable and factual reports with recommendations
- Thorough knowledge of current principles and practices associated with claims investigations, adjustment and related practices
- Extensive knowledge of medical and legal terminology with a thorough understanding of Legal principles/litigation management
- Ability to handle confidential information
- Ability to communicate effectively with others both orally and in writing
- Ability and willingness to learn quickly and utilize new skills because of rapidly changing information and/or technology
- Ability to comprehend multi-state laws and regulations to assist other offices, as necessary