Job Title: Liability Claims Adjuster

Department/Agency: US Admin

Location: Oak Ridge, TN office – Remote opportunity

About US: US Administrator Claims, LLC manages, adjusts, and controls insurance claims filed against the workers’ compensation and commercial general liability policies of multiple carriers across the country. The difference between US Administrator Claims and other third-party administrators is our approach to claims handling.  Everything we do on behalf of your business is customer-driven. Fr

One size does not fit all. For those accounts identified as requiring a claims advocate, we will assign an account manage dedicated to your program. If your program requires a specific skillset or proper administration and management, rest assured, we have the claims professionals you need.

US Administrator Claims, LLC stands apart from our competitors and looks forward to working with you to turn those inevitable losses into a profitable solution.

Job Summary: Review, process and handle general liability claims as assigned by claims supervisor to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations and identify subrogation of claims and negotiate settlements. Communicate directly with clients, physicians, and attorneys to manage claims in a timely and economic manner.

Essential Duties and Responsibilities include the following. Other duties may be assigned:

• Investigate newly assigned claims by making 3-point contact (client, claimant, physician) within a 24-hour period.
• Inquire and probe for information with clients and claimants to determine nature and cause of injury; verify all parties agree on incidents.
• Contact physicians to obtain medical diagnosis and projected treatment plan.
• Record claimant statements to verify information and claim status.
• Determine and assess if benefits due and liability of claims through evaluation of claim.
• Respond to all inquiries and requests from clients, physicians, and attorneys in a timely manner.
• Draft and send written communications for follow-up as needed with all involved parties.
• Document all information from contacts with clients, claimants, physicians, and attorneys into the claims system.
• Review and process daily paperwork, mail or communication relating to claims status.
• Maintain diaries and files for medical records and legal documents for claims.
• Calculate and pays benefits due; approve and makes timely claims; manages reserve adequacy throughout the life of the claim.
• Set reminders to follow-up on tasks through a diary on the system, check diaries daily.
• Review legal bills for accuracy and approve for payment.
• Consult with outside medical counsel to obtain pre-certification approval for specific treatments when needed.
• Coordinate and monitor litigation with attorneys. Prepare necessary state fillings within statutory limits.
• Evaluate settlement amounts with client; negotiate settlement with claimants and attorneys.
• Handle claims involving subrogation from investigation through recovery including talking to witnesses, obtaining police reports, and communicating with legal contacts and third-party insurance companies.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Uses appropriates cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Ensures claims files are properly documented and claims coding is correct.

• Refer cases as appropriate to supervisor and management.

Qualifications

• High school Diploma or equivalent is required
• 3-5 years prior experience handling auto/general liability claims/ or an equivalent combination of training, education and experience.
• Strong organization skills, attention to detail and the ability to multi-task and prioritize work are required.
• Analytical thinking skills are needed to properly evaluate complex claims
• A strong attention to detail is necessary as claims adjusters must carefully review documents and policies
• Good verbal and written communication skills, as well as interpersonal skills are required, experience with negotiations, knowledge of litigation process is preferred.
• Ability to listen well and negotiate with constituents is needed.
• Ability to speak a second language is an asset
• Basic computer skills or the ability to quickly learn new software are required
• A strong work ethic and time management skills is needed, to efficiently handle a large caseload
• Ability to establish and maintain good rapport with clients and claimants is needed.
• Ability to calculate figures is required

Physical Demand

While performing the duties of this job, the employee is regularly required to sit; stand; use hands to finger, handle, or feel; and talk or hear. The employee is occasionally required to walk; reach with hands and arms; and stoop, kneel, crouch, or crawl. Specific vision abilities required by this job include close vision. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This description is not meant to be all-inclusive and may be modified from time to time at the discretion of management.

Acrisure is committed to employing a diverse workforce. All applicants will be considered for employment without attention to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran, or disability status.  California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at www.Acrisure.com/privacy/caapplicant.
 

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