Risk/Cost Management firm near Old Town Scottsdale is looking for a full-time mid to senior level lost time adjuster. In this position you will have oversight of moderate to difficult workers’ comp losses for our clients. You will have considerable contact with adjusters at various carriers, with treating physicians and with our clients at a management level. In this position you may occasionally have to set up a new loss in our system, follow up on securing modified duty releases from clinics, and make sure that our clients offer modified work before the end of the waiting period. Other duties to include tracking data for OSHA reporting and making sure adjusters have an action plan in place to drive file closure and that they are working that plan. Must me pro-active and assertive. Multi-state experience is preferred.


If interested please e-mail resume to bhesse@wccamerica.com

Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE: To analyze complex or technically difficult claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within company standards, industry best practices and specific client service requirements; and to manage subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
1. Analyzes and processes complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
2. Assesses liability and resolve claims within evaluation.
3. Negotiates settlement of claims up to designated authority level.
4. Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout the life of the claim.
5. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
6. Prepares necessary state filings within statutory limits.
7. Manages the litigation process; ensures timely and cost effective claims resolution.
8. Coordinates vendor referrals for additional investigation and/or litigation management.
9. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
10. Manages claim recoveries, including but not limited to subrogation, Second Injury Fund recoveries and Social Security offsets.
11. Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
12. Communicates claim activity and processing with the ill or injured party and the client; maintains professional client relationships.
13. Ensures claim files are properly documented and claims coding is correct.
14. Refers cases as appropriate to supervisor and management.
15. Maintains a quality assurance program to support the total performance management initiative and the consistent delivery of quality claims service.
QUALIFICATIONS
Education & Licensing
Baccalaureate degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.

Experience
Four (4) years of claims management experience required.

Skills & Knowledge
• In-depth knowledge of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent negotiating skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace

Jurisdictional Experience Required: CO and AZ

License or Certification(s) Required: AZ



Go to: www.sedgwickcms.apply2jobs.com/ProfExt/index.cfm?fuseaction=mExternal.showJob&RID=1562 to Apply.

Law Firm seeking Senior Workers’ Compensation Claims Examiner to fill a full time paralegal position: Downtown Phoenix Law Firm is looking for a senior claims examiner with 5-7 years of experience handling workers’ compensation matters to work as a paralegal.

Candidates should be organized, hardworking, self-motivated, flexible, resourceful, have attention to detail and have interest in working in a fast pace legal environment. Spanish speaking is a plus. Qualified candidates should have experience with meeting deadlines, have good writing skills, and have knowledge regarding Arizona Workers’ Compensation. Successful candidates must possess a four-year degree and/or a Paralegal Certification.

Please provide resume, along with list of references, and salary requirements to Andrea Jacob at ajacob@scheldruplaw.com or P.O. Box 36 Cedar Rapids, IA 52406.

SUMMARY:
Manage all accepted lost time claims, except specified serious injuries or complex claims that cannot be resolved within approximately 7 months.

PRIMARY DUTIES:
Perform telephonic case management of Workers Compensation claims that are assigned.
Contact injured worker, employer and medical providers in a timely manner to gather relevant info to assist in the investigation and evaluation of the claim. Manage to conclusion all lost time claims with 6 months duration or less. .
Manage files with an emphasis on file quality (including timely contact and proper documentation), maximizing internal resources, and achieving a positive end result by returning injured party to work.
Aggressively pursue claim resolution opportunities.
Build strong partnership with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services to the injured worker.
Identify claim issues as they arise, and take appropriate steps to resolve them or refer them to the Unit Manager for reassignment.
Establish appropriate reserves to reflect claim exposure.

EDUCATION/COURSE OF STUDY:
College degree is preferred.

WORK EXPERIENCE:
Workers Compensation claim handling experience including investigations skills, resolution skills, evaluation, negotiation and reserving skills

OTHER:
Complete understanding of all policy, coverage and endorsement implications, and AOE/COE issues
Technical and jurisdictional and case law knowledge.

File Management
Technical
Customer Focus/ Communication
Relationship Management
Technology

Travelers is an equal opportunity employer. We actively promote a drug-free workplace.

Chris L. Smith, AIC, WCCP
Travelers and Constitution State Services
P.O. Box 29047, Phoenix, AZ 85038-9047
(602) 861-8731 direct line
(877) 314-9862 Fax