Claims Adjuster - licensed in Kentucky / Nebraska / Indiana - REMOTE

un Claims Adjuster - licensed in Kentucky / Nebraska / Indiana - REMOTE Dedicated Tech Services, Inc. image 1 of 1 compensation: $35/hr. DOE employment type: experience level: mid level job title: Claims Adjuster Company and Role: Dedicated Tech Services, Inc. (DTS) is an award-winning IT consulting firm based in Columbus, OH. We now have an opening for a Claims Adjuster. Highlights and Benefits: Remote W2 hourly pay rate up to $35/hour or salaried equivalent Structured and Results-Driven culture. Direct W2 hourly or salaried applicants only (no corp-to-corp subcontractors, third parties, or agencies) Paid time off and holidays for salaried employees 401K, billable bonus, and health, life, vision, dental and short-term disability insurance options for all DTS is a proud Women Business Enterprise (WBE) and Woman Owned Small Business (WOSB)! Check out our benefits and company information at www.dtsdelivers.com! Job Description: Methodically evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims to their most cost- effective conclusion for Kentucky, Nebraska and Indiana claim handling. Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision. Take recorded statements when necessary. Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines. Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels. Establishes and maintains reserve values within authority limits, which accurately predict the loss reflecting the current known circumstances of the claim. Actively develops the investigation of and pursuit of subrogation recoveries when possible. Consults with supervisor or technical support staff on unusually complex claims. Investigates, evaluates and negotiates settlements, applying technical knowledge and human relation skills to effect fair and prompt claim closure and to contribute to a reduced loss ratio. Redirects the claim to the appropriate subject matter expert if the claim becomes significantly complex or presents significantly increasing financial exposure. Applies effective protocols for medical management, litigation, fraud/abuse and recovery. Effectively manages litigation in conjunction with legal counsel. Presents claims and participates in discussion at team staffing. Works collaboratively with injured employee, employer, outside counsel, health and rehabilitation professionals to manage the claims costs, promote quality medical care and timely return-to-work to achieve optimal cost-effective medical and vocational outcomes. Required Skills and Experience: Bachelor's Degree from an accredited college or university is preferred. Must have three years of experience in the insurance, claims investigation, legal, rehabilitation, or medical claims processing. Workers' compensation claims experience mandatory. Must display skills and experience in industry's best practices commensurate with Encova's published Best Practices for Claims Management. Knowledge of best claims practices and laws, court procedures, precedents and government regulations. Ability to apply relevant information and individual judgment to determine whether events or processes comply with laws, regulations or standards. Ability to recognize and analyze new or changing information that could affect the claims handling strategy and/or potential claims cost, and effectively use the information to manage the claim. Demonstrated ability to work effectively in a team environment. Demonstrated ability to use logic and sound reasoning to identify alternative solutions for problem-solving. Demonstrated understanding of how to apply general rules to specific problems to produce workable solutions. Ability to develop specific goals and plans to prioritize, organize, and accomplish work. Demonstrated proficiency in evaluating the relative costs and benefits of potential actions to choose the most appropriate one. Skilled in the use of computers and claims management systems and other typical business-related programs. Demonstrated ability to develop and maintain strong, effective internal and external relationships. Ability to work effectively in a paperless environment. US Citizens and those authorized to work in the US are encouraged to apply. We are unable to sponsor at this time. Dedicated Tech Services, Inc. is an Equal Opportunity Employer Principals only. Recruiters, please don't contact this job poster. post id: ... updated: [ ]