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Aegis LLC, A Charles Taylor Company, is the general administrator for Wisconsin County Mutual Insurance Corporation and Community Insurance Corporation. Both companies provide liability, property, and workers compensation insurance to governmental entities in the state of WI.
Job Summary
The Workers Compensation Claims Adjuster is responsible for managing all aspects of a workers compensation claim which includes determining compensability, verifying coverage, administering disability and medical benefits, skillfully negotiating claim resolutions, troubleshooting and assisting injured employees, employers and medical/legal professionals with any service needs throughout the lifespan of a claim.
We are looking for an adjuster with a minimum of 5 years of experience handling indemnity level claims in the state of WI. This is a fully remote position however ideal candidates are a resident of WI, IL, MN, IA or MI.
Essential Functions
- Receives newly reported claims
- Maintains and updates claim notes throughout lifespan of claim
- Records claim information in electronic database
- Interviews claimants, insureds, medical professionals and witnesses to determine claim validity
- Communicates claim compensability decisions to claimant, employer and medical provider
- Sets appropriate reserves based on nature/extent of injury
- Calculates lost time wages, makes disability payments directly to claimants and diaries future payments as appropriate
- Reports all mandatory claims data directly to Wisconsin Dept of Workforce Development within required timeframes
- Orders independent medical examination as necessary and prepares all relevant documentation for physician review
- Maintains regular correspondence with claimants, insureds, and nurse case manager to include claim updates, medical appointments, or issues with disability payments.
- Reviews and processes medical bills through third-party vendor for additional discount opportunities
- Aggressively collaborates with claimants and insureds to ensure early return-to-work is pursued
- Works in partnership with legal counsel to warrant that insured’s interests are protected on litigated claims which includes providing all relevant claim documentation needed for defense counsel to successfully defend claim and evaluate ultimate claim exposure
- Attends settlement conferences, mediations, and hearings on behalf of the insurance company/insured
- Reviews and approves defense attorney bills within authority
- Works with underwriting to help provide relevant information on losses for renewal rates as well as Risk Management to identify trends and may interact with agents for insureds on losses
- Responds to State requests for health cost disputes, applications for hearings and penalty assessment letters
- Identifies subrogation potential and pursues recovery
- Leads claim reviews with clients as requested
- Other duties as assigned
Requirements
- 5+ years of previous, progressive Workers Compensation indemnity level claims adjusting experience within the state of WI
- Knowledge of relevant workers compensation laws
- Multi-State Adjuster license preferred
- Experience working with public sector employers
- Ability to negotiate issues and settlements
- Strong focus on customer service which includes timely response to requests/inquiries
- Ability to adapt to changing technologies and learn functionality of new equipment and systems
- Coursework in workers compensation, insurance, business or related field
- Proficiency in entire Microsoft Office suite
- Strong grasp of medical terminology
- Familiarity with medical cases and how treatment typically progresses
- Excellent oral and written communication abilities
- Attention to detail and good organization skills
- Ability to establish and maintain effective working relationships with others
- High School education
Charles Taylor offers a competitive salary commensurate with experience and excellent benefits including medical, dental, vision, life insurance and 401(K) with match. If you are seeking a career where you can achieve great things for great clients in a supportive and collaborative environment, then we may be the place for you.
Equal Opportunity Employer
Here at Charles Taylor, we are proud to be an Inclusive Employer. We provide an environment of mutual respect with zero tolerance to discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex or sexual orientation.
Our external partnerships and the dedicated work we do in promoting a transparent and fair recruitment and selection process all contribute to the successful, inclusive and diverse culture and environment which we are proud to be a part of at Charles Taylor.
Values
Demonstrate and champion Charles Taylor Values by ensuring Agility, Integrity, Care, and Accountability and Collaboration.
Job Type: Full-time
Benefits:
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Monday to Friday
Application Question(s):
- How many years of experience handling workers' compensation claims for public municipalities do you have?
- How many years of experience handling claims that involve subrogation do you have?
- How many years of experience handling workers' compensation claims in the state of Wisconsin do you have?
- Are you able to independently evaluate and negotiate settlements?
Work Location: Remote
