Workers Compensation Claims Adjuster

Company Overview:

AmCOMP Incorporated is a dynamic, entrepreneurial and growing company with over 450+ employees and offices throughout the Midwest, Northern, Southeast, Southern, MidAtlantic and Texas.  We have more than two decades of involvement in the insurance business, and we specialize in providing effective workers’ compensation protection to businesses and their employees. The company’s vision is to be the most respected company in our industry. 

 

Position Summary:

Our Louisville, Kentucky Claims Office is seeking a Workers’ Compensation Adjuster with a Kentucky Claims Adjuster License to handle a mixed case load of medical only and lost time claims. The position requires experience in  performing  functions to process claims involving medical benefits only or those with medical benefits and a limited level of indemnity benefits, determine compensability, set reserves, and process payments, within the limits of standard or accepted practice under the Kentucky Workers’ Compensation Statute.

 

Primary Job Responsibilities:

1.  Receive and review information related to new claims including medical benefits only and limited lost time from work. Communicate with injured workers, employers, and medical providers and prepare contact reports. Determine compensability based on contact information, accident reports, and statutes.  Set up file diaries, establish reserves up to authority level, submit reserves recommendations of higher level for authorization, and file required State forms. Document follow-up care, actions taken to settle claim and other claim related activity.

2.  Analyze required medical treatment relating to injury, set reserves up to authority and initiate reserves over authority level for authorization by supervisor.

3. Follow up with contacts to medical provider and insured employer regarding injured workers’ progress. Review reserves and adjust as required. Support the process by scheduling medical or testing appointments and providing authorizations. Write letters to injured workers and providers to determine appropriateness of medical care being received related to injury.

4.  Assign case to contractor for investigation of circumstances when compensability is questionable.

5.  Review and respond to incoming mail, emails, telephone calls, and fax transmissions from providers and injured workers, related to caseload. Take actions required to respond to mail.

6.  Review and approve or deny medical bills, returning bills with insufficient information and adjusting reserves as required based on bills received. Process bills in the bill paying and tracking system or issue for processing by others; prepare documents for payment and filing.

7. Identify, investigate, and pursue subrogation cases. Contact attorneys and other necessary parties and create and submit forms and letters required.

8.  May assign and direct work to the Claims Assistant.

9.  May develop information for and participate in Risk Review and Agency Review meetings to provide insight and recommendations regarding retention or corrective actions that may be required.

10.   May attend to hearings and mediations as necessary.

11.Conduct business at all times with the highest standards of personal, professional and ethical conduct.

 

Ideal Candidate:

The ideal candidate is required to  posses a Kentucky Claims Adjuster License and at least 3 years experience handling Kentucky Workers’ Compensation claims.  Must possess excellent verbal and written communication skills, excellent computer skills, ability to identify and resolve claim issues including a working knowledge of (KRS 342).

 

Interested Candidates:

We offer an excellent benefits package and generous Paid Time Off program, in addition to a casual yet entrepreneurial working environment.  We pride ourselves on our commitment to being an Employer of Choice and believe our employees are our most important asset.  If you are interested in learning more about AmCOMP, please visit our website at www.amcomp.com   EOE.

 

Candidates who believe they are an “Ideal Candidate� should tell us why in a cover letter and provide a resume as well. You may respond to the CareerBuilder posting or directly to the hiring manager at msenger@amcomp.com

 

Making our Vision a reality, one employee at a time.

 

LOCAL CANDIDATE ONLY- This is an office position which requires the candidate to reside within Metro Louisville or the immediate surrounding counties.