Lost Time Claims Adjuster
ClearPath Mutual
Louisville, KY
medical
management
clearpath
medical management
payments
attorney
defense
subrogation
referrals
vendors
workers compensation
wage
treatment
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June 7, 2023
ClearPath Mutual
Louisville, KY
FULL_TIME
Summary
This job entails the medical management of each assigned claim, lost wage payments, settlements and correspondence as needed.
Essential Duties and Responsibilities include, but are not limited to the following:
- Investigates assigned claims and makes a determination of the compensability of each claim. Does initial set up of claim. Maintains a file on each assigned claim.
- Makes lost time claim payments on claims deemed compensable.
- Corresponds and discusses with physicians the medical treatment involved in each claim. Maintains regular contact with the employer and claimant during the duration of the claim.
- Handles the settlement of assigned claims within the authority given by the Claims Manager.
- Oversees the litigation of any claims with a Form 101 or Medical Fee Dispute. Controls the cost of the attorney fees involved and directs the defense attorney on the defense of the claim.
- Follows up on any claim involving subrogation and handles fully until subrogation lien is recovered.
- Makes reports to the excess carrier when the claim meets the reporting requirements of the excess carrier and/or recovery is needed on a claim that exceeds the SIR.
- Enters notes into the claims computer system on all activity involving the claims assigned.
- Corresponds with all appropriate parties regarding the claims handled.
- Makes proper referrals to rehab management vendors for medical management and/or vocational placement. Makes proper referrals for surveillance with private investigative vendors.
- Reviews files on diary for closure, reserves and update of notes in accordance with ClearPath Mutual policy and procedures.
- Other duties as necessary and assigned by management.
Qualifications & Experience
- Must have Kentucky Workers’ Compensation Lost Time claims handling experience- Indiana and Tennessee would be an added bonus.
- Bachelor’s degree strongly preferred; minimum of 2 years of experience
- Must hold an Adjuster’s license in KY.
- Must possess a high level of negotiation skills and be able to effectively handle conflict and emotional issues that arise in the arena of workers compensation claims
- Ability to muti-task and handle large volumes of work
- Must have knowledge of accepted industry standards and practices.
- Must have knowledge of state laws and regulations pertaining to the WC insurance industry.
- Experienced with Claims software.
- Must have the ability and desire to learn new technology and processes.
- Must have professional experience communicating across the organization at all levels.
Physical Demands & Environment
Work is performed in an office environment and involves typing, talking, sitting, standing, walking, bending, reaching, and lifting of objects up to 20 pounds.
ClearPath Mutual is an Equal Opportunity Employer. ClearPath Mutual does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need.
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