Workers Compensation Adjuster-Full-Time-Days

Work in collaboration with Workers Compensation Manager to process workers’ compensation claims for the health system. Position requires high level of communication and analytical skills, particularly in dealing with sensitive and confidential information regarding workers’ compensation claims. Investigate employee injury events, conduct interviews, and file required documentation with governing State agencies, manage and maintain assigned workers' compensation claims, daily diary events and database tracking.

Responsible for approval of all levels of workers' compensation claims. Review and verify payments for services provided and disability amounts in conjunction with the workers' compensation program and individual claims. Major Job FunctionsThe following is a summary of the major essential functions of this job.

The incumbent may perform other duties, both major and minor, that are not mentioned below. In addition, specific functions may change from time to time:Investigate and analyze data to determine compensability in accordance with the NC Workers’ Compensation ActManages assigned workers' compensation claims in a timely mannerAttend workers' compensation mediations and NC Industrial Commission hearings as requiredIndependently works within certain limits and authority to actively manage a caseload of complex lost time casesEstablish claim reserves, propose and negotiate settlements under the supervision of the Workers’ Compensation Program ManagerApprove disability and medical payments and other expenses related to workers' compensation claimsReview employee incident report to determine which employee injury/illness incidents meet OSHA recordability criteria and documents individual files in database accordinglyPrepares NC Industrial Commission forms and dispatches them to responsible partiesCollect, enter, and update information in workers' compensation software databaseMaintain claims diary and completes diary items in timely mannerReview and verify bills for services provided in conjunction with workers' compensation program and individual claimsAuthorize check requests for workers' compensation benefits, medical payments, case management bills, settlement checks in addition to other miscellaneous expensesAssist with preparation for workers' compensation legal proceedingsKeeps current with laws and regulatory requirements related to workers' compensation and OSHA to assist the Health System in maintaining compliance with sameMaintain strict confidentiality of all documentation, information, and work-productOther duties as assignedMinimum QualificationsThe following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:Education and Formal Training: Associate’s degree in business or a related field is requiredBachelor’s degree preferredCurrent North Carolina Claims Adjuster's License and in good standing requiredValid North Carolina driver’s license requiredWork

4 years’ experience in workers' compensation claims administration required3 years’ of experience in safety, legal, and insurance environment preferredKnowledge, Skills, and Abilities Required: Proficiency in reading, writing, and speaking the English languageKnowledge of North Carolina workers' compensation lawUnderstanding of litigation processes and importance of documentationKnowledge of OSHA regulationsAbility to work with people in a professional, tactful, and diplomatic wayAbility to work independently and accomplish tasks in timely mannerAbility to organize and prioritize activities and tailor procedures to a smoothly functioning departmentAbility to work with variety of changing activities from entering data into computer database to making highly technical decisionsAbility to hold in confidence highly sensitive information and materialsProficiency with Microsoft Office software (e.g., Outlook, Word, Excel, etc.)Proficiency with the use of a claims database, e.g., iVOS or another insurance carrier’s databasePhysical

Ability to move throughout the hospital system facilitiesReaching, handling, and finger dexterity to operate office machinesWalking and ability to climb for investigating incidents sites throughout the hospital system facilitiesAbility to drive is needed to investigate off-campus incident sitesTalking and hearing is essential for communicating with others and conducting interviewsManual dexterity is needed for manipulating equipment and handling toolsVisual acuity for inspection of equipment and Health System environs in conjunction with incident investigations, reviewing data and reportsAbility to lift up to 20 poundsRequired Licenses and CertificationsCape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity