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CLAIMS ADJUSTER I - 60025238
State of South Carolina - Lexington, SC
posted 2 months ago
About the position
The Claims Adjuster I position at the South Carolina State Accident Fund involves working as part of a Claims Services team to manage and process workers' compensation claims. The role focuses on recording and monitoring claims, determining compensability, negotiating settlements, and providing assistance to various stakeholders. This entry-level position is ideal for individuals looking to start a career in state government and offers opportunities for professional growth within the agency.
Responsibilities
- Record all accepted or denied body parts, lost time, and return to work dates.
- File all appropriate forms timely and accurately in accordance with the SC Workers' Compensation Law.
- Record all diagnoses, surgeries, and settlement justifications.
- Consult with Claims Manager before referring any potential files for Third Party or Reinsurance.
- Monitor all claims in accordance with agency policy and procedures as outlined in the training manual.
- Determine compensability of claims within 10 days and monitor all lost time periods substantiated by medical documentation.
- Perform a monthly claims review and a plan of action for all assigned claims.
- Pay all related bills within 14 days.
- Attend Claims Review Team meetings as necessary.
- Review cases with Claims Manager and obtain authority for settlements above $10,000.00 following recommendations to the policyholder.
- Negotiate settlements with claimants or attorneys and prepare all necessary forms with guidance from the Claims Manager.
- Attend mediations, hearings, and clincher conferences when necessary.
- Review and monitor all reserves throughout the duration of claims and consult with Claims Manager on reserves over $25,000.00.
- Assist injured workers, policyholders, medical providers, attorneys, and other stakeholders via telephonic, electronic, or written medium in a timely and professional manner.
- Handle special projects and perform other duties as may be required and/or assigned.
Requirements
- Bachelor's degree in a relevant field.
- Ability to obtain a valid South Carolina Insurance Adjuster's License within 12 months after being hired.
Benefits
- Paid parental leave
- Paid holidays
- Disability insurance
- Health insurance
- Dental insurance
- Employee assistance program
- Vision insurance
- Loan forgiveness
- Life insurance
- Retirement plan
