26-050 Claims Adjuster or Senior Claims Adjuster

Claims Adjuster POSITION SUMMARY: Independently investigate, evaluate, negotiate, settle and adjust claims in accordance with MD Workers' Compensation Law and internal Guidelines. DUTIES AND RESPONSIBILITIES: 3Independently investigates assigned claims, following sound claims handling techniques in accordance with company claim philosophy and quality assurance standards, and in accordance with the Maryland Compensation Law. 3With limited assistance from unit supervisor, review all relevant data, evaluates claims, determine coverage & compensability, set reserves and negotiates settlement within settlement authority. 3Documents files with necessary reports, investigative notes, and other data as may be required by Maryland Workers' Compensation Law, the company and the unit supervisor. Advise supervisor on status of problematic claims. 3Prepares files for hearing, develops defense of issues, identifies witnesses and makes decisions regarding appeals. 3Attends hearings, mediations, settlement conferences, pre-trial hearings and fraud trials. 3Provide superior customer service to all internal and external stakeholders and the claims public. Complies with standards for service and prompt contact. Keeps agents and policyholders informed of claim status as appropriate. Anticipates and promptly responds to all issues and concerns. 3Manages personal caseload effectively in accordance with claims standards and guidelines and demonstrates the ability to learn, develop and manage complex cases. 3Demonstrates effective understanding of workers' compensation claim handling to include evaluation and calculation of average weekly wage, disability ratings, reserves. 3Demonstrates an understanding of the impact of Medicare on workers' compensation claims to include Medicare Set-Asides and Conditional Payments. 3Performs other duties as assigned. 3Pursuit of continued education and professional development of industry knowledge. 3Contributes to the achievement of established department goals and objectives; adheres to departmental policies, procedures, quality and safety standards, and consistently exhibits Chesapeake's Values and Behaviors. SKILLS, EDUCATION AND EXPERIENCE: 3Bachelor's degree and 2-4 years of industry-related experience or 5-8 years equivalent work experience including 3 years of workers' compensation claims adjusting. 3Attainment of AIC certification or comparable certification in insurance. 3Knowledge of claims basics including administrative procedures and processes, law, reserving, investigation, calculation of benefits, case management, fraud, subrogation, etc. 3Must be a detail-oriented, flexible self-starter, with excellent written and verbal communication skills, capable of handling multiple tasks in a challenging environment. 3Bilingual skills strongly preferred. POSITIONAL COMPETENCIES: 3Bias for Action 3Deliver Results 3Personal Leadership 3Knowledge Sharing 3Service and Sales Excellence 3Teamwork and Communication PHYSICAL DEMANDS: While performing the duties of this job, the teammate is regularly required to sit, use hands and fingers, handle or feel objects, tools or controls; reach with hands and arms. The teammate is occasionally required to stand, walk, stoop, kneel, crouch or crawl. The teammate may occasionally lift up to 30 pounds. Specific vision abilities are required which include close vision, peripheral vision and the ability to adjust focus. WORK ENVIRONMENT: Office environment. The noise level is usually moderate. SALARY: $64,605-$96,907 (per year, commensurate with experience) Senior Claims Adjuster POSITION SUMMARY: Independently investigate, evaluate, negotiate, settle and adjust claims in accordance with MD Workers' Compensation Law and internal Guidelines, manage more complex claims and mentor others. DUTIES AND RESPONSIBILITIES: 3Independently investigates claims, following sound claims handling techniques in accordance with company claim philosophy and quality assurance standards, and in accordance with the Maryland Compensation Law. 3Reviews all relevant data, evaluates claims, determines coverage and compensability and negotiates within settlement authority. 3Documents files with necessary reports, investigative notes, and other data as may be required by the Maryland Workers' Compensation Law, the company and the unit supervisor. Advise supervisor on status of problematic claims. 3Prepares files for hearing, develops defense of issues, identifies witnesses and makes decisions regarding appeals. 3Attends hearings, mediations, settlement conferences, pre-trial hearings and fraud trials for assigned files, and accompanies less experienced personnel as requested. 3Assists in the training, mentoring and development of less experienced staff and, upon request, assumes supervisory duties in supervisor's absence. 3Provide superior customer service to all internal and external stakeholders and the claims public. Complies with standards for service and prompt contact. Keeps agents and policyholders informed of claim status as appropriate. Anticipates and promptly responds to all issues and concerns. 3Manages personal caseload independently and effectively in accordance with claims standards and guidelines, demonstrating the ability to handle cases of various levels of complexity. 3Demonstrates effective understanding of workers' compensation claim handling to include evaluation and calculation of average weekly wage, disability ratings, and reserves. 3Analyze and exhibit a higher level of understanding of claims financial exposure directly impacting the business. 3Demonstrates an understanding of the impact of Medicare on workers' compensation claims to include Medicare Set-Asides and Conditional Payments. 3Performs other duties as may be dictated by department circumstances. SKILLS, EDUCATION AND EXPERIENCE: 3Bachelor's degree and 4-7 years of claims adjusting experience or 10 years equivalent work experience including 5 years of workers' compensation claims adjusting and AIC designation or comparable designation. 3Basic keyboarding and math skills. 3Bilingual skills preferred. 3Must be a detail-oriented, flexible self-starter, with excellent written and verbal communication skills, capable of handling multiple tasks in a challenging environment. POSITIONAL COMPETENCIES: 3Customer Experience Management 3Analytical Thinking/Problem Solving 3Communicating Effectively 3Decisiveness 3Drive for Results 3Organizational/Time Management PHYSICAL DEMANDS: While performing the duties of this job, the employee is regularly required to sit, use hands and fingers, handle or feel objects, tools or controls; reach with hands and arms. The employee is occasionally required to stand, walk, stoop, kneel, crouch or crawl. The employee may occasionally lift up to 30 pounds. Specific vision abilities are required which include close vision, peripheral vision, and the ability to adjust focus. WORK ENVIRONMENT: Office environment. The noise level is usually moderate. SALARY: $69,780-$104,670 (per year, commensurate with experience) What We Offer We offer a competitive benefits package that includes health, vision, and dental coverage, a robust PTO plan, an 8% employer contribution to retirement regardless of team member contribution, educational assistance, and opportunities to participate in team member appreciation events. Additionally, we provide STD, LTD and group life insurance 1X a team members salary. You'll also enjoy free tickets to community attractions, all part of our commitment to providing a high quality of work life. You will have the flexibility to thrive in a hybrid work environment and an opportunity to participate in development and volunteer programs.