Job Description

Job Description

Job Description

Job Title : Claims Adjuster – Workers Compensation

Location : Bartlesville, OK

Hire Type : Contingent

Pay Range : $32/hour

Work Type : Full-time

Work Model : Remote

Work Schedule : Monday – Friday, 8am – 5pm

Nature & Scope:

Positional Overview

The Imagine Group is recruiting for a Claims Adjuster – Workers Compensation on behalf of our client, a leading provider of technology-enabled risk, benefits and integrated business solutions, specializing in claims management and supporting services across multiples industries in Bartlesville, OK .

In this role, you will be responsible for managing and resolving employee injury claims with accuracy, empathy and efficiency. The position involves investigating claims, determining coverage and liability, coordinating medical treatments, and ensuring compliance with state regulations and company procedures.

Role & Responsibility:

Tasks That Will Lead to Your Success

• To analyze mid and higher-level workers’ compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiating settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.
• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travel as required.

Skills & Experience

Qualifications That Will Help You Thrive

• License Required in these states any one to include in reciprocity: AL, AR, FL, GA, IA, IL, IN, KS, KY, MI, MN, MO, MS, NC, NE, OK, SC, SD, TN, WI
• Bachelor's degree from an accredited college or university preferred.
• Four (4) years of claims management experience or equivalent combination of education and experience required.
• Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skills.
• Good interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Service Expectations.

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