Workers' Compensation Adjuster

Job Description

Job Description

We are seeking a motivated, detail-oriented Workers' Compensation Adjuster to joint our home health care organization. This role will work closely with injured employees, office leadership, and our Third-Party Administrator (TPA) to support the day-to day-management of Workers' Compensation claims while helping ensure injured employees receive timely care and support.

This is an excellent opportunity for someone early in their Workers' Compensation or claims career.

POSITION SUMMARY : Under moderate supervision, will perform a variety of functions related to the management of the company's Workers' Compensation claims and other aspects of the Employee Claims and Safety office (ECS) through: 1) hands on management and creation of policies and practices, 2) preparing reports, analysis, and presentations, and 3) providing administrative and project support to your supervisor.

MINIMUM QUALIFICATIONS :

• Four (4) year college degree preferred.
• Minimum two (2) years of experience in Workers' Compensation claims handling.
• Basic proficiency in handling litigated Workers' Compensation claims.
• Demonstrated proficiency in effectively and timely communicating with service offices, injured employees, and Third-Party Administrator.
• Demonstrated record of strong interpersonal skills.
• Proven record of goal achievement.
• Able to handle multiple tasks.
• Ability to arrange information and files in a useful manner.
• Proficient in Microsoft computer products including Word, Excel, PowerPoint, and Outlook.
• Acceptable pre-employment assessment results.
• Ability to read, write and effectively communicate in English.

PRIMARY RESPONSIBILITIES :

• Learn various aspects of the organization through technology training, hands-on learning, cross-training, and site visits.
• Ensure accurate completion of clerical functions such as the routine maintenance of reliable claim notes, records, and reports.
• Understand the company's policies as well as the applicable state Workers' Compensation laws that govern our work.
• Act as a trusted advisor and become a subject matter expert with regard to Employee Claims functions and processes.
• Support the team (office and company) and provide backup as needed.
• Provide customer service for routine claim questions, and direct more complex issues to BAYADA's third party administrator.
• Handle a caseload between seventy-five (75) and one hundred fifty (150) active Workers' Compensation claims while maintaining accurate and complete information on each assigned file.
• No greater than 5% of caseload will be valued at greater than BAYADA's current deductible.
• Proficiency in infectious disease claims and communicating and implementing the associated BAYADA policies.
• Ensure that each BAYADA office has a reliable Panel List of Providers and maintain regular contact with office directors to guarantee continued satisfaction with ECS's outside medical vendors.
• Ensure that each work-related injury is reported within the state's filing deadline.
• Obtain timely medical reports from claimant's treating physicians and promptly inform BAYADA office staff of the findings.
• Schedule follow-up appointments for any claimant who misses a regularly scheduled medical visit.
• Coordinate placement of injured workers in modified or light-duty placements as directed by their treating physician; seek alternate work assignments for claimants if job opportunities do not exist within the company; facilitate completion of the company's light-duty payroll on a weekly basis.
• Timely investigation of claims.
• Appropriate and accurate coding of claims.
• Continue to develop knowledge base of claims handling and jurisdictional knowledge through claims handling and independent research.
• Timely completion of Action List items.
• Ability to accurately evaluate and present settlement evaluations/recommendations.
• Proven ability to progressively work in a more independent fashion with moderate direction.
• Proactively works and collaborates with Third Party Administrator (TPA) and defense counsel to create effective strategies.
• Ongoing analysis of exposure and recommendations for mitigating the exposure and resolution of the claim is evidenced.
• Identification of and escalation of Third-Party Administrator service issues through to resolution.
• Continuously evaluate defense counsel and other strategic partnerships to ensure effectiveness and address issues as needed.
• Assist in the creation and management of policies, practices and procedures related to BAYADA's Employee Claims and Safety office.
• Initiate and independently research claim information through compilation of statistics, analyzing data and summarizing findings for review.
• Participate in special projects: prepare reports and presentations using Microsoft Office (Word, PowerPoint etc.)

BAYADA believes that our employees are our greatest asset:

• Base Pay: $27-29 / hour plus bonus potential depending on qualifications
• BAYADA offers a comprehensive benefits plan that includes the following: Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct deposit and employee assistance program
• To learn more about BAYADA Benefits, click here

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As an accredited, regulated, certified, and licensed home health care provider, BAYADA complies with all state/local mandates.

BAYADA is celebrating 50 years of compassion, excellence, and reliability. Learn more about our 50th anniversary celebration and how you can join in here.

BAYADA Home Health Care, Inc., and its associated entities and joint venture partners, are Equal Opportunity Employers. All employment decisions are made on a non-discriminatory basis without regard to sex, race, color, age, disability, pregnancy or maternity, sexual orientation, gender identity, citizenship status, military status, or any other similarly protected status in accordance with federal, state and local laws. Hence, we strongly encourage applications from people with these identities or who are members of other marginalized communities.