Adjuster -Workers Comp Claims Medical

Overview

Adjuster I-Workers Comp Claims Medical Only role at CopperPoint Insurance Companies
. Nevada-based Workers’ Compensation Medical Only Claims Adjuster responsible for analyzing reported medical-only claims to determine compensability and process medical benefits in compliance with company standards and regulatory requirements. Residence in Nevada or Nevada adjuster’s license is required; licensure in other states (AZ, CO, UT, NM, TX, OK, MO, KS) is highly desirable.

• Analyze and investigate medical-only claims to determine compensability by interpreting and applying workers’ compensation laws, rules, and regulations.
• Monitor injured workers’ status to ensure timely conversion to indemnity; utilize all available resources as appropriate.
• Proactively manage claims in accordance with company standards and statutory requirements; establish and maintain cost drivers and data elements for accurate state regulatory and Medicare reporting.
• Build and maintain professional customer relationships; communicate claim actions with customers; document communications and claim management activities.
• Ensure timely payment of medical benefits; actively use cost containment measures and programs (e.g., subrogation and vendors).
• Identify coverage issues and potential fraud and subrogation concerns.
• Complete special projects as assigned by manager and perform other duties as needed.

• Strong technical claims knowledge with experience in workers’ compensation and other commercial lines claims management.
• Knowledge of Department of Insurance (DOI), National Council on Compensation Insurance (NCCI), and state regulatory rules and regulations.
• Ability to analyze, interpret, and apply laws, rules, and regulations pertaining to workers’ compensation.
• Ability to stay current with statutory, industry rules, and company policy changes affecting claims management.
• Ability to set priorities, manage time, organize work, and meet deadlines.
• Excellent customer service skills, initiative, mature judgment, and discretion.

• Bachelor’s degree (B.S. or B.A.) in business administration, communications, or related field from an accredited four-year college or university preferred, and/or a minimum of 2 years related experience in NV workers’ compensation medical-only claims adjusting.
• This is not an entry-level position; prior NV claims handling experience is required.
• Minimum 4+ years of full-time work experience in commercial insurance may be used as a substitute for a degree.
• Certifications are preferred, not required.
• Associates in Claims (AIC);
  Workers’ Compensation Claims Administration (WCCA);
  Workers’ Compensation Claims Professional (WCCP); CPCU, IEA, or SIP certifications or equivalents preferred.

• Medical, dental, vision, short-term and long-term disability, life insurance, health savings account, flexible spending account, and 401(k) plan eligibility for employees and their families.
• Basic life insurance and AD&D at two times annual salary, short- and long-term disability, and Employee Assistance Plan provided at no cost to the employee.
• Paid time off accrue at 0.0769 hours per paid hour (up to approximately 20 days per year) plus 10 paid holidays annually.

• $51,500.00 - $66,000.00 annually
• Compensation may vary based on skills, experience, education, and location.
• In addition to base salary, potential annual discretionary bonus.

CopperPoint Insurance Companies, founded in 1925, is a leading provider of workers’ compensation and commercial insurance solutions with a growing ten-state footprint in the western United States. CopperPoint is an equal employment opportunity employer and maintains a drug-free workplace. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status, or any other protected characteristic.

CopperPoint supports volunteerism and offers a range of benefits and programs.

• Seniority level:
  Mid-Senior level
• Employment type:
  
  Full-time
• Job function:
  Finance and Sales
• Industry: Insurance