- Description: PRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency. Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments. Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. Manages subrogation of claims and negotiates settlements. Communicates claim action with claimant and client. Ensures claim files are properly documented and claims coding is correct. May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review. Maintains professional client relationships. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Experience Four (4) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure 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 skill Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations 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.
- Requirements: Below details should reflect in the resume:
Need to possess GA license.
Min 3 years of experience required.
Litigation claims experience mandatory.
Remote.
GA and Southeast experience preferred. -
Claims Adjuster
4 days ago
Sedgwick Memphis, United StatesTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
-
Automotive Mechanical Claims Adjuster
1 week ago
American Auto Shield Memphis, United States** Automotive Mechanical Claims Adjuster** · **Job Category****:** Claims **Requisition Number****:** AUTOM001950 Showing 1 location **Job Details** · **Description** · **Were looking for remote Automotive Mechanical Claim Adjusters that are passionate about helping others and ...
-
Field Property Claims Adjuster
1 week ago
Liberty Mutual Insurance Memphis, United StatesPay Philosophy · The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these p ...
-
Field Property Claims Adjuster
3 weeks ago
Liberty Mutual Memphis, United StatesPay Philosophy · The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these ...
-
Field Property Claims Adjuster
2 weeks ago
Liberty Mutual Insurance Memphis, United States OTHERPay PhilosophyThe typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these posi ...
-
Seeking Bodily Injury Claims Adjusters
3 weeks ago
Morgan & Morgan Memphis, United States**Seeking Bodily Injury Claims Adjusters** · at Morgan & Morgan, P.A. Memphis, Tennessee, United States At Morgan & Morgan, the work we do matters. For millions of Americans, were their last line of defense against insurance companies, large corporations or defective goods. From ...
-
Pharmacy Call Center Specialist
3 weeks ago
Regional Medical Center of Memphis Memphis, United States# Regional One Health is currently seeking a#Pharmacy Call Center Specialist# A Brief Overview In accordance with state and federal regulations, responsible for data entry, patient registration, and resolving third party rejects in a call center setting. Works under supervision t ...
-
Claims Examiner
3 weeks ago
TAJ Technologies Inc Memphis, United StatesPRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best prac ...
-
Field Auto Technical Adjuster
2 weeks ago
VetJobs Memphis, United StatesJob Description · ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spou ...
-
Field Auto Technical Adjuster
3 weeks ago
VetJobs Memphis, United StatesJob DescriptionATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, ...
-
Support Services
1 week ago
Building Plastics, Inc. Memphis, United StatesJob Description · Job DescriptionSummary of Key Job Functions: · Prepares source documents for computer entry by compiling, sorting, and organizing documents; resolving questionable data; setting daily priorities. · Maintains claims system by inputting claims and credit requests. ...
-
Remote Revenue Cycle Specialist- A/R
3 weeks ago
NSN Revenue Resources Memphis, United StatesJob Type · Full-time · Description · We are seeking an experienced and detail-oriented Accounts Receivable Specialist to join our central billing office team for ambulatory surgery centers. The successful candidate will play a crucial role in resolving outstanding surgical clai ...
-
Specialist-Billing
2 weeks ago
Baptist Memorial Healthcare Corporation Memphis, United StatesSummary · Responsible for the daily completion of both claims edit, denial, and no response billing functions for timely follow up. Handles internal and external questions to completion. Understands both paper and electronic claims as well as client invoice billing. Performs ot ...
-
Specialist-Billing - MG CBO Billing
2 weeks ago
Baptist Memorial Memphis, United StatesSummary · Responsible for the daily completion of both cliams edit, denial, and no response billing functions for timely follow up. Handles internal and external questions to completion. Understands both paper and electronic claims as well as client invoice billing. Performs oth ...
-
Field Auto Technical Adjuster
3 weeks ago
Allstate Insurance Company Memphis, United StatesThe world isn't standing still, and neither is Allstate. We're moving quickly, looking across our businesses and brands and taking bold steps to better serve customers' evolving needs. That's why now is an exciting time to join our team. You'll have opportunities to take risks, c ...
-
Specialist-Customer Care II
1 week ago
Baptist Memorial Memphis, United StatesSummary · Responsible for daily customer inquiries from internal and external customers to completion. Responsible for the daily completion of both claims edit, denial, and no response billing functions for timely follow up. Handles internal and external questions to completion. ...
-
Entry Level Virtual/Field Property Adjuster
1 week ago
Avail Car Sharing Company Memphis, United States**Entry Level Virtual/Field Property Adjuster - Memphis, TN** · **Location:** Memphis, TN, US * We cover the cost to help you study for and earn your license · We offer 3 months of full paid training plus on the job training for up to an additional 3 months · Ongoing training ...
-
Revenue Cycle Specialist- Surgical Claims
1 week ago
NSN Revenue Resources Memphis, United StatesJob Type · Full-time · Description · Company Overview: At NSN Revenue Resources, a part of USPI (United Surgical Partners International), we are the largest Ambulatory Surgery Center network in the United States. We foster a culture of innovation, collaboration, and excellence. ...
-
Account Executive
1 week ago
VIRTUS Memphis, United StatesA winner of Best Places to Work in Insurance seven years in a row, Virtus is looking for innovative individuals to join our fast-paced, rapidly growing team headquartered in Overland Park, Kansas. Virtus is a next generation insurance consulting firm that focuses on middle market ...
-
Property Adjuster
16 hours ago
Allstate Benefits Memphis, United StatesThe world isn't standing still, and neither is Allstate. We're moving quickly, looking across our businesses and brands and taking bold steps to better serve customers' evolving needs. That's why now is an exciting time to join our team. You'll have opportunities to take risks, c ...