- Advanced Knowledge of claims function and processes.
- Ability to effectively communicate with internal and external customers.
- Strong understanding of workers compensation or disability claims management, strategies, resolution techniques and adjusting.
- Technical capability to enter first reports of injury and to adjust lost time and non lost time claims utilizing the features of the TPA claim management systems.
- Participates in claim advocacy and negotiations, including claim denials, reserving files, and claim reporting, issuing payments, attending hearings, conciliations or mediations and filing of state forms.
- Determine compensability of the claim as it relates to the worker compensation jurisdiction.
- Review and approval of loss time, medical services and expenses to be paid of the claims file.
- Plan and attend claim reviews with clients, carriers and auditors.
- Ability to identify client issues, build a plan towards resolution, execute and manage internal and external expectations effectively.
- Analyzes claims based on the TPA best practices as outlined in the "Policy and Procedures" manual.
- Ideal candidate will have a minimum 5 years of claims adjusting experience.
- College degree preferred but high school diploma or graduate equivalent degree required.
- Proficient-to-expert in MS Office suite of products.
- Must be licensed in all jurisdictions handled.
- Superior written and oral communication skills.
- Ability to work well in a team environment.
- Must have strong analytical thinking and problem-solving skills.
- Strong organizational skills required.
- Strong negotiation skills required.
- Recognized as one of Insurance Business America's Top Insurance Employers for six consecutive years
- Named to Business Insurance's annual list of the Best Places to Work in Insurance four years in a row
- Recipient of the American Heart Association's Gold Status for a maintaining a culture of health and well-being five years in a row
- Visit our for a complete list of industry awards and recognitions
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TPA Claims Specialist II - Buffalo, United States - USI Insurance Services
Description
General Description:
Adjuster of lost and non lost time claims for workers compensation.Responsibilities:
Knowledge, Skills and Abilities:
Unrivaled Resources and Support What truly distinguishes USI as a premier insurance brokerage and consulting firm is the , a game-changing value proposition that delivers to clients a robust set of risk management and benefit solutions with bottom-line financial impact. USI ONE represents Omni, Network, Enterprise—the three key elements that set USI apart from the competition. Through USI ONE, we develop strategic, timely and effective risk management and benefit programs in terms that are easy to understand, and we demonstrate how the solutions can have a positive economic impact.
Industry-Leading Programs, Rewards, and Recognition In addition to competitive pay, incentives, and benefits, USI recognizes associates through our Summit Awards program, rewarding excellence in those who build our brand each day. USI offers that recognize outstanding achievement and help our associates lead healthy, productive lives. We turn care into action with our award-winning wellness program, college scholarships for associates' children, and financial help in times of need
Deep Community Engagement We are committed to giving back to our local communities and supporting a culture of environmental sustainability. From sharing our time, talent, and resources to support local non-profit organizations, animal shelters, and environmental beautification and restoration projects – to partnering with eco-conscious vendors and taking steps to reduce our own environmental footprint – we're working to build a better future.
Committed to a Diverse, Equitable, and Inclusive Workplace Our award-winning diversity, equity, and inclusion program educated our associates to help them better understand and serve our clients, prospects, fellow team members, and local communities through curated education and training resources, employee support programs, and community outreach initiatives to build a more diverse, equitable, and inclusive culture.
Nationally Recognized as a Top Insurance Employer
USI is committed to providing a full-suite of competitive benefits for our growing population and its diverse needs. We offer a wide range of health, welfare and financial benefits including medical, wellness, dental and vision, 401(k), flexible spending and health savings accounts, short and long-term disability, life insurance and other unique employer-sponsored and voluntary programs. USI also offers a generous paid time off policy, paid family leave benefit as well as paid holiday time .
$50,000-$60,000
