Claims Adjuster

Employer
CRS Group
Location
New Haven
Salary
Competitive
Posted
Feb 08, 2018
Closes
Feb 14, 2018
Industry
Accounting
Employer Type
Direct Employer
Employment Type
Permanent
Hours
Full Time
Job Description

Job Description:

  • Responsibility for oversight of Clients Workers Compensation Program
  • Responsible for building consensus and managing risk to the Client
  • Responsible for building, maintaining, and managing relationships with claims adjusters, insurers, legal counsel, and other claims related parties

Claims Handling Oversight:

  • Responsibilities include claims monitoring, providing direction to TPA management, and communicating with employees, managers, insurance carriers, doctors, internal and external counsels, and medical networks. Responds to questions and issues
  • Reviews first reports of injury for red flags, correct coding of injury type, body part, etc.
  • Advises adjusters of any needed corrections or feedback
  • Reviews TPA initial investigation results and provides feedback and direction to adjuster as necessary
  • Ultimate decision maker on questionable claim approvals and on all denials, relying primarily on experience and complexity of each case. To do so
  • Consults with Director and legal counsel as necessary
  • Works with TPA and legal counsel to ensure timely processing and management of claims
  • Oversees work of TPA, external legal counsel, and others involved with each case, and provides direction as necessary
  • Authorizes nurse case management when applicable
  • Authorizes special investigation, including surveillance, when applicable
  • Reviews and authorizes changes in case reserves and settlement amounts as requested by adjuster in accordance with the Clients special account instructions
  • Oversees activities of external workers compensation attorney for cases involving litigation
  • Works with TPA and legal counsel to identify claims appropriate for full and final settlement Provide recommendation to Director and, as necessary, the Office of the General Counsel
  • Partners with internal clients, managers, HR partners, union reps, to ensure adherence of internal processes; protocols (i.e., after 1 year. prioritize cases on the KTK report and partner with HRGs on next action steps)
  • Develop, coordinate, implement and administer work procedures and policies for workers' compensation claims
  • Continuously reviews existing administrative procedures for opportunities for improvement in relation to design, practices, implementation, communication
  • Works with location management and third party administrator to successfully return injured worker to work

Administrative Functions:

  • Participates in claims audits and file reviews to ensure compliance with best practices in claims handling, TPA internal processes and Clients specific account instructions for handling
  • Works with TPA and Workers compensation attorney regarding preferred provider network
  • Recommends changes to the network to the Managed Care Committee
  • Works with the Office of Risk Management, analyze claim data and identify trends; Work with the Office of Risk Management and the affected department to develop and implement risk control and risk reduction programs
  • Files annual application with the State of Connecticut Insurance Department for self-insurance status
  • File required reports to the State of Connecticut Insurance Department and to the State of Connecticut Treasurers office
  • Serves as the subject matter expert to answer questions regarding process, regulations, or complex issues. Maintain and continuously update current knowledge of Connecticut Workers' Compensation Laws
  • Attends conferences, provides updates to leadership on findings, trends, best practices, etc. and seek to implement changes in current practices/protocols where possible
  • Maintains State of Connecticut Insurance Department Casualty License
  • Assists in overall vendor management process, including providing regular feedback on performance, and negotiating contract terms and conditions
  • Generates reports from TPA and legal counsel to audit data accuracy of our cases; ensure terminations occur; identify trends
  • Dives deeper to find root cause of claims in order to determine if trends are taking place or new practices/processes need to be implemented
  • Partners with Business operations in the reconciliation of financials - workers comp checks; payments; medical expenses; that are provided from the vendor and into the Risk Envision system in coordination with Clients RMIS systems

Qualifications:

  • 10 years of experience adjusting or managing workers compensation claims - past employers could be Travelers, Sedgwick etc any TPA
Company Description As a preferred direct supplier for Fortune 100 and Fortune 500 companies nationwide, we have been selected by our customers due to the quality of services provided, our communications and our relationships built with our consultants and our managers.

The CRS Group (Computer Resource Solutions, Inc.) - is an Information Technology, Professional Staffing and Managed Services firm that has been in business for over 23 years. CRS was founded in 1994, headquartered in Itasca, and is one of Chicago largest privately held IT firms with staff and services in over 32 states.

CRS's ability to be flexible and responsive to their clients needs has allowed them to add CRS Professional, a separate division providing an additional line of service, offering solutions in accounting / finance, administrative, and many other specialized services. Some of the nation's largest companies choose us as their preferred provider of IT talent, why not add your talent to our team?

For more information on The CRS Group, please visit: is a leading provider of strategic staffing solutions for the Information Technology and Communications community.

CRS is an Equal Employment Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, gender identity, protected veteran or disabled status.

CRS will not sponsor applicants for work related visas. The successful candidate will be required to submit evidence of identity and employment authorization.

CRS recruiters will never send emails via personal email accounts (example -gmail, yahoo, Hotmail, ymail, etc...)

Passion * People * Performance