Provide Workers' Compensation (“WC”) claims adjusting in support of BIW's self-insured/self-administered WC program and provide guidance to injured employees. Effectively and efficiently manage a book of claims by reviewing open claims at a regular cadence and documenting medical management with internal and external providers. Timely review new claims for compensability determinations and processing qualified claimants in accordance with strict regulatory agency rules and regulations; and accurately file State and Federally mandated forms in accordance with strict agency rules and regulations.
Operating under the BIW Business Operating System (BOS), the (Adjuster II/II) ensures compliance with safety, quality, and performance standards while coordinating with other key stakeholders to meet overall milestones.
Key Responsibilities
Safety Leadership:
- Identify and report out any and all opportunities for prevention or mitigation of injuries during the review of claims and related data & reports.
Project Execution:
- Participate in the analysis of compliance reports and provide feedback as required.
- Assist in the process of internal and external financial and claim audits as required.
- Provide assistance and back-up for internal and external reporting, including quarterly CMS (Centers for Medicare & Medicaid Services) reconciliation reports.
- Evaluate claim exposure, establish case reserves, negotiate and resolve claims. Work closely with defense counsel on litigated claims to develop litigation plan. Attend mediation and hearings as necessary.
- Review for reasonableness and approval of medical invoices in accordance with treatment plans.
Training and Development:
- Keep up to date on State and Federal laws as well as Medicare reporting requirements.
- Assist and educate employees and supervisors/managers on respective roles and responsibilities in managing WC claims.
Team Collaboration and Communication:
- Work closely with Medical Dept., Operations, Human Resources, Labor Relations, and other functional areas to promote early return to work
- Other administrative duties as assigned by the Director of Risk Management.
Continuous Improvement:
- Regular participation in process improvement and/or change management activities within the department and as part of larger teams.
- Identify opportunities for continuous process improvement and work closely with team members toward achieving same.
- Interact with State and Federal agencies to provide claim data and answer questions.
