MDD Forensic Accountants logo
MDD Forensic Accountants

Making Numbers Make Sense

Senior WC Claim Adjuster

GeneralGeneralFull TimeRemoteSeniorTeam 201-500Since 1933H1B No SponsorCompany SiteLinkedIn

Location

Maryland

Posted

59 days ago

Salary

$80K - $85K / year

Seniority

Senior

High School5 yrs expEnglish

Job Description

Senior WC Claim Adjuster

MDD Forensic Accountants

• Investigate assigned Florida Workers’ Compensation claims • Evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim while setting appropriate reserves • Provide benefits and initiate state filings promptly while exercising discretion and independent judgement • Initiate investigation and assign defense counsel when appropriate • Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments • Timely proper completion of State filings • Handle EDI filings and rejections in conjunction with EDI adjuster • Monitor medical treatment in conjunction with assigned Nurse Case Manager • Review, document, and approve medical bills for payment within three days of receipt • Authorize appropriate medical services as outlined per Florida Statute 440.13 • Determine whether vocational rehabilitation services are needed for an employee to return to work • Coordinate light duty availability and reasonable accommodations with medical providers and employers • Maintain adequate reserves for life of claim utilizing reserve worksheets, ODG Guidelines, Workers’ Computation software and Davies Claims North America reserving philosophy • Attend client meetings as necessary, and maintain regular telephone contact to ensure client satisfaction • Maintain diary and workflow requirements • Maintain working knowledge of FL Workers’ Compensation Statutes and Rules, and their application • Direct defense counsel in handling of litigation claims with defense input, make timely decisions regarding litigated issues • Protect Medicare’s interest in conjunction with MMSEA Section 111 Reporting requirements • Review claims for possible red flags • Demonstrate capability of identifying and pursuing subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden • Request reimbursement at least quarterly and follow up for timely receipt from excess carrier(s) • Adhere to client profile instructions • Report any overall account or client concerns to the supervisor or upper management • Report any E&O concerns to the QA Manager and Executive Vice President • Maintain 97% claim closure ratio

Job Requirements

  • Must reside within the state of Maryland
  • Multiple years’ experience handling several types of claims
  • Presumption claims handling experience
  • Experience with depositions, mediations, and litigation
  • Experience with IDatix, Reference Books-Periodicals, Workers Computation, ISO, ShoreTel
  • 3-5 years of Lost Time/Legal claims handling experience; preferred 5+ years
  • Possess FL-All Lines Adjuster or Workers’ Compensation License and maintain CEU credits for license
  • Previous experience with settling claims
  • Experience with Microsoft Office Suite

Benefits

  • Medical, dental, and vision plans to support your health and that of your family
  • A 401(k) plan with employer matching
  • Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
  • Paid holidays
  • Life insurance and short‑term and long‑term disability coverage
  • Paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements

Related Categories

Related Job Pages

More General Jobs

Full TimeRemoteTeam 201-500Since 1933H1B No Sponsor

• Adjust third party General Liability, Auto Liability, Errors and Omissions, and Law Enforcement claims involving bodily injury • Daily review of workflow and claim system reminders with follow up on tasks • Review new claims assignments within 24 hours of assignment • Contact with the insured/claimant within 24 hours of assignment • Assign appraisers or coordinate estimates of damage • Gather evidence of damages • Interview or obtain recorded statements from involved parties • Request payment authorization according to client guidelines • Professional and timely communication with the client • Maintain a 95% claim closure ratio • Follow Davies Claims North America guidelines when settling claims involving a Medicare recipient

Virginia
$57.5K - $70K / year
Survivor Healthcare logo

Advanced Practice Provider

Survivor Healthcare

A virtual health clinic dedicated to treating patients from the point of diagnosis through treatment and beyond.

General59 days ago
Full TimeRemoteTeam 11-50Since 2016H1B No Sponsor

• Conduct comprehensive intake evaluations for new patients, identifying unmet needs, goals, and limitations • Develop and support individualized care plans in collaboration with a multidisciplinary care team • Provide education to patients and referring clinicians on survivorship-focused care • Support and guide interdisciplinary team members in patient treatment planning • Communicate with patients’ oncology teams and primary care providers as appropriate • Deliver compassionate, patient-centered care via a secure telehealth platform

Utah
$135.2K - $156K / year
Full TimeRemoteTeam 501-1,000

• Engage with cardiologists / endocrinologists / healthcare professionals / stakeholders to educate on clinical and scientific evidence to advance treatment landscape as aligned with strategic imperatives • Educate on RNAi technology, hypertriglyceridemia, familial chylomicronemia syndrome, and hypercholesterolemia • Synthesize and communicate clinical and scientific insights to internal stakeholders • Attend and present at scientific congresses and meetings to stay up to date with the latest scientific developments and trends in cardiometabolic therapeutic area • Respond to unsolicited inquiries consistent with MSL compliance standards • Support company sponsored clinical trials through investigator site engagement • Support speaker training as requested and ensure speakers are up to date with evolving disease and product data • Support national, regional, and local scientific congresses including Opinion Leader (OL) engagement, session coverage, booth, and company debriefs • Monitor and analyze scientific publications, clinical trials, and competitive landscape in the cardiometabolic therapeutic area • Maintain clinical and scientific expertise and general industry business acumen • Advance MSL value proposition, demonstrate tact and professionalism, and deliver results • Act in accordance with company policies • Develop territory specific OL and account plans including OL profiles, pre-call planning, and follow up plans • Communicate clinical and scientific information in an accurate and clear manner • Document MSL quantitative and qualitative accomplishments • Provide scientific support for Med Info inquiries, ensuring accurate and timely responses to healthcare professionals' queries • Develop scientific content for medical education initiatives • Support Medical Affairs as needed with special projects and initiatives • Sophisticated cross-functional relationship management is critical for success

United States
GitLab logo

Candidate Experience Specialist

GitLab

GitLab, founded in 2011 and based in San Francisco, California, maintains a distributed team of professionals that work remotely across multiple continents. Git

General60 days ago
ContractRemoteTeam 2,500Since 2014

• Collaborate with Recruiters, hiring teams, and Recruiting leadership to understand and execute the hiring plan for each job requisition. • Coordinate with Recruiters to maintain accurate, up-to-date hiring process information in the applicant tracking system and GitLab repositories. • Manage candidate scheduling and act as the Recruiting Coordinator to organize interviews and keep hiring processes running smoothly. • Ensure candidates receive timely, thoughtful, and engaging communication at each stage of the hiring process. • Help manage candidate traffic for all roles, monitoring pipelines and flagging issues or bottlenecks to the recruiting team. • Create and stage employment contracts for candidates receiving offers on behalf of hiring managers and Recruiters. • Partner with People Operations to create a seamless handoff for new team members joining GitLab. • Promote GitLab's values, culture, and all-remote approach in every interaction, acting as a brand ambassador for potential team members.

Singapore