Sr. Adjuster, Workers' Compensation

Job Description

Provide Workers' Compensation (“WC”) claims adjusting in support of BIW's self-insured/self-administered WC program to include, but not limited to:

• Timely review of new claims for compensability determinations and processing qualified claimants in accordance with strict regulatory agency rules and regulations.
• Responsible for accurate and timely filing of State and Federally mandated forms in accordance with strict agency rules and regulations.
• Effectively and efficiently manage -book of claims by reviewing open claims at a regular cadence and documenting medical management with internal and external providers.
• Provide assistance and guidance to injured employees and providers.
• Review for reasonableness and approval of medical invoices in accordance with treatment plans.
• Identify opportunities for continuous process improvement and work closely with team members toward achieving same.
• Interact with State and Federal agencies to provide claim data and answer questions.
• Work closely with Medical Dept., Operations, Human Resources, Labor Relations, and other functional areas to promote early return to work.
• Evaluate claim exposure, establish case reserves, negotiate and resolve claims. Work closely with defense counsel on litigated claims to develop litigation plan. Attend mediation and hearings as necessary.
• Keep up to date on State and Federal laws as well as Medicare reporting requirements.
• Participate in the analysis of compliance reports and provide feedback as required.
• Assist in the process of internal and external financial and claim audits as required.
• Provide assistance and back up for internal and external reporting, including quarterly CMS (Centers for Medicare & Medicaid Services) reconciliation reports.
• Other administrative duties as assigned by the Director of Risk Management.

Required/Preferred Education/Training

• Bachelor's Degree in Business Administration or equivalent combination of education and experience required.

Required/Preferred Experience

• 5 years of experience in Workers’ Compensation Claims Administration required.
• Advanced knowledge of MS Office required.
• Experience in process improvement and/or change management required.
• Experience with PeopleSoft, WFM, and ATS a plus.
• Knowledge of Federal and State regulatory compliance requirements a plus.
• Strong organizational, interpersonal, and communication skills.
• Self-motivated & team-oriented..
• High attention to detail required.
• Able to maintain confidentiality of highly sensitive information.
• Must be able to manage conflict and have strong decision making skills.
• Must have adjuster license.