Workers Compensation Claims Adjuster en Unisonriskadvisors

Working at RCM&D and Unison Risk Solutions is ideal for those seeking a challenging, rewarding and upwardly mobile career in risk management, insurance and employee benefits. Dedicated to fostering their continued success and growth, we are deeply invested in our employees.

Job Summary

Investigate and manage all aspects of Workers’ Compensation claims, primarily in Maryland, in accordance with jurisdictional requirements to the best possible resolution.

Essential Functions

• Review, examine, investigate, and analyze indemnity workers’ compensation claims.
• Interact with injured employers to ensure awareness and understanding of the workers’ compensation process, requirements, and entitlements.
• Investigate compensability issues, including taking recorded statements.
• Determine compensability of workers’ compensation claims.
• Coordinate medical treatment for injured employees and provide information to treating physicians regarding employee’s medical history, health issues, and job requirements.
• Serve as a liaison between medical providers, employees, and employer departments; and inform departments of an injured employee’s work restrictions and coordinate appropriate accommodations.
• Review and interpret doctor’s reports to ensure that the appropriate American Medical Association (AMA) guidelines have been applied.
• Communicate with defense attorneys regarding litigated cases; make recommendations regarding proposed strategies for claim resolution.
• File appropriate jurisdictional forms.
• Calculate and issue indemnity payments.
• Approve medical payments timely on assigned claims.
• Monitor medical treatment on assigned claims.
• Provide proactive claim management, including documenting plans of action for moving claims toward closure.
• Assign Nurse Case Managers and Vocational specialists, when appropriate.
• Issue denial letters to providers and claimants, when appropriate.
• Communicate status reports to employer and excess carriers.
• Make recommendations regarding claim handling and resolution.
• Reserve claims based on most probable outcome.
• Maintain a diary on all open claims.
• Attend hearings, trials, and mediations, when appropriate.
• Prepare claim summaries and attend quarterly claim review meetings with employers.
• Monitor hearing date, consideration date logs and timely payments of WCC Awards.
• Develop and maintain professional relationships with assigned clients through timely communication to client.
• Adhere to SISCO standards and procedures.
• Document claim activity in claim processing system, Spear.
• Additional job duties as assigned.

Minimum Education/Abilities/Skills

• High school diploma or GED; some college preferred.
• Possess 5+ years’ experience performing the duties of this position or one with similar requirements.
• Excellent written and oral communication skills are necessary
• Must possess strong interpersonal skills and is able to work collaboratively and professionally with internal and external stakeholders; able to work independently or in concert with the team.
• Maintain a client-centric focus.
• Must possess solid organizational skills, prioritization skills, and a strong attention to detail.
• Exhibit strong time management skills; possess the ability to work under pressure and meet deadlines and deliverables. 
• Adept at interpreting data and information.
• Demonstrates a willingness to learn.
• Contribute to team efficiency by sharing knowledge and best practices.
• Able to deal with change and ambiguity.
• Demonstrate agility and the ability to multi-task, as well as pivot to changing priorities, as circumstances warrant.
• Must be proficient with Microsoft Office Suite, and experience with claim management software is a plus.

RCM&D, a Unison Risk Advisors company and founding member of Assurex Global, is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Finding and cultivating talent is a hallmark of our organization. RCM&D looks for the best and brightest risk management, insurance and employee benefits professionals to join our firm. As a growing and vibrant business, we also recruit savvy marketing, sales, finance, human resources, technology and administrative colleagues to manage and operate our business.