The Workers Compensation Medical Only Adjuster - REMOTE OPPORTUNITY

Employment Type

: Full-Time


: Miscellaneous

GuideOne is a community for good. We exist to help our members achieve their goal of making the world a better place. Our Claims department is critical to our success, because this department has contact with members who are under stress from having suffered a crisis. We offer reassurance, sympathy and expert guidance as we help them recover, alleviating much of their worry. We serve as a real partner to our members by efficiently, quickly processing claims so they can resume their life's work without unnecessary delay. Our Claims department welcomes people who are optimistic, enjoy helping others in times of need and are compassionate about making positive change in the world. The Workers Compensation Medical Only Adjuster position will be responsible for the timely set up and handling of all new Medical Only Workers' Compensation claims. The incumbent must be able to conduct an initial review, investigation and evaluation of new losses assigned on low exposure & low complexity claims to conclusion. Job responsibilities will include contacting insureds, medical providers, and in some cases injured workers, by phone, mail and email. The workers' compensation Medical Only adjuster will also be expected to set appropriate claim reserves within established authority level, document claim files pursuant to GuideOne's Claim Best Practices, and ensure that timely payments or other appropriate actions are in accordance with jurisdictional requirements. This position will work out of their home office and require a moderate level of supervision. Familiar with standard claims concepts, practices, and procedures. Relies on general experience and judgment to plan and accomplish goals. Performs a variety of tasks. A certain degree of creativity and latitude is required. Depending on state requirements, the position may require a state adjusters license. If licensure is required, the workers' compensation Medical Only adjuster will be expected to obtain the appropriate adjuster license and comply with all requirements. As the Workers Compensation Adjuster, Medical Only, you will be responsible for the following; * Investigates coverage, determines compensability, initiates and controls delivery of accurate and timely compensation workers' compensation benefits, monitors medical management, determine accurate and adequate reserves on assigned claims. * Provides accurate assessments and negotiates fair and efficent claims resolutions while managing costs. Settles losses according to the documented damage, the language of the policy of insurance, pertinent regulatory and statutory considerations and within granted authority. * Prepares written communication, including but not limited to settlement letters, disclaimers of coverage and reservation of rights letters * Maintains effective claim file documentation and diary system. Monitor diary to achieve timely development of file and timely disposition of the claim * Recognizes and pursues recovery opportunities and prepares submissions to SIU when indicated * Assigns and supervises vendor resources, including but not limited to independent adjusters, engineers and other experts as needed * Recognizes and pursues recovery opportunities and prepares submissions to SIU when indicated * Assumes additional duties as defined. Education & Experience: * Bachelors degree preferred * Prior medical only adjusting experience preferred but may be substituted with insurance-related course work or certifications. * Knowledge of Workers Compensation law. * Ability to take responsibility and work independently in a home based environment. * Strong communication and analytical skills are required. * Ability to negotiate skillfully in difficult situations. * Must have strong organizational and time management skills. * Ability to formulate sound expense, indeminity, and business judgment while supporting loss evaluations and presenting them effectively. Additional Skills & Qualifications: * State licensing or certification where required. * Basic computer skills including Microsoft applications Word, Excel, Outlook and the Internet. * Perform work related simple and advanced mathematical problems and calculations. * Compose written correspondence and factual reports which are well-organized and concise, utilizing proper English, grammar, punctuation and spelling. * Demonstrates the ability to use commonly-used claims concepts, practices and procedures. * Must meet or exceed the ability to demonstrate the 5 core and common compentencies outlined below. * Convey clear, concise information to others, using verbal or other appropriate communication techniques. * Complete formal training plan and assignments as required. * Treat others in a nondiscriminatory, lawful and ethical manner, respecting the differences among people, and the value they bring to GuideOne. * Follow safe practices in all work activities to avoid injuries and accidents. About GuideOne: GuideOne Insurance was founded upon two key philosophies that endure to this day: a commitment to social responsibility, and a dedication to serving customers in select niche markets. At GuideOne Insurance, we believe that our people are our greatest asset. We encourage our employees to work towards common goals and succeed together. GuideOne is a recognized expert in providing Commercial Lines insurance and financial services to: * Churches and Houses of Worship * Small Businesses * Educational Institutes * Non-Profit Organizations * Programs Business * Specialty Lines of Business Rich Benefits Package: * 401K includes a match up to 6% at 100%. * Generous time off program including; personal, holiday, and volunteer paid time off. * Flexible work schedules. * Wellness incentives. * Free Basic Life and AD&D. * Free short-term and long-term disability. * Educational assistance program. * 3 different medical plans options to meet individual needs, including dental and vision. * Company sponsored community volunteer opportunities. No immigration sponsorship is offered for this position This Company Participates in E-Verify Background Check Required

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