Senior Claims Adjuster

Job not on LinkedIn

🔥 0 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Trean Insurance Group

WebsiteLinkedInAll Job Openings

51 - 200 employees

💼 Consulting

🛡️ Insurance

💰 $50M Post-IPO Debt on 2022-08

Consulting • Insurance

Trean Insurance Group is a full-service insurance management and reinsurance consulting company. The company offers expertise in insurance and reinsurance accounting, claims, data, regulatory, and underwriting. Trean Insurance Group prides itself on being relationship-driven and acts as a true business partner to its clients, providing customized insurance and reinsurance solutions. With a focus on achieving client goals and developing profitable business, Trean Insurance Group combines underwriting, claims, loss control, and analytical expertise for successful, enduring partnerships.

📋 Description

• Manage complex workers compensation claims and assist in determining benefits due to injured workers • Ensure ongoing claim adjudication meets company standards, industry best practices, and statutory and regulatory requirements • Contact employers, injured workers, and medical providers within 24 hours for new lost-time claims • Complete claim determinations, acceptance/denial letters, wage determination letters, appeals forms, regulatory notices, and timely benefit payments • Establish and document average or estimated wages and reconcile payments when verified wages are obtained • Approve or deny medical bills within 24 hours and ensure timely repricing and payment • Identify medical providers and treatment plans; assign nurse case managers for complex or unusual medical care • Record communications, determinations, and correspondence in the claims system; scan and add documents in the paperless office • Manage legal aspects of claims and assign and direct designated attorneys • Assign investigations, including surveillance, medical surveys, and social media checks, when required • Ensure legal, managed-care, and other expense bills are paid timely • Respond to phone calls, voicemails, and emails within stated timeframes • Direct claims assistants and clerical staff on assignments, document copying, medical appointment scheduling, and filing • Establish a Plan of Action for each claim and update it monthly • Monitor claims for reinsurance or excess insurance reporting and provide initial and quarterly reports • Perform other assigned activities and duties

🎯 Requirements

• High school diploma or GED required • Bachelor’s degree or equivalent experience preferred • 5 or more years’ claims experience preferred • Insurance industry knowledge required • Excellent analytical skills • Strong verbal and written communication skills • Strong organizational skills