WORKERS’ COMPENSATION CLAIMS ADJUSTER

Midwestern Insurance Alliance (MIA) is seeking a full-time Claims Adjuster to join its worker’s compensation claims processing team.
MIA is a national workers’ compensation program administrator offering custom-tailored worker’s compensation insurance programs through its carrier partners. MIA focuses on niche segments such as local and long-haul trucking, parcel and mail delivery, and fuel hauling. MIA’s acquisition by San Diego-based K2 Insurance Services in 2012 has enabled MIA to expand its product offerings and product distribution channels.

Claims Adjuster responsibilities include, but are not limited to:

• Thoroughly investigating worker’s compensation claims by contacting injured workers, medical providers, and employer representatives.
• Determining if claims are valid under applicable worker’s comp statutes.
• Communicating with medical providers to develop and authorize appropriate treatment plans.
• Reviewing and analyzing medical bills to confirm charges and treatment are worker’s comp injury-related and in accordance with the treatment plan.
• Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes.
• Calculating and assigning appropriate reserves to claims, and managing reserve adequacy throughout the life of the claim.
• Managing claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
• Preparing required state filings within statutory limits.

• Providing information as needed for litigation or settlement negotiations.

  The ideal Claims Adjuster will have:

• Bachelor’s degree preferred, but not required.

• At least 2 years’ WC claims adjusting experience that includes experience with California WC claims.
• AB1262 California Experienced Examiner designation or currently meet the requirements for designation under AB1262. WCCA or WCCP preferred.
• Strong verbal and written communication skills.
• Strong organizational skills with attention to details.
• Ability to work with little supervision.
• Ability to manage multiple tasks in a fast-paced environment.
• Proficiency in MS Word, Excel, and Outlook.

MIA offers the opportunity to join an established company in growth mode. Our benefits package includes medical, dental, vision, disability, and life insurance and 401(k) with employer match. We also offer a business casual work environment and an 8:00-5:00 Monday-Friday work week.

• Thoroughly investigating worker’s compensation claims by contacting injured workers, medical providers, and employer representatives.
• Determining if claims are valid under applicable worker’s comp statutes.
• Communicating with medical providers to develop and authorize appropriate treatment plans.
• Reviewing and analyzing medical bills to confirm charges and treatment are worker’s comp injury-related and in accordance with the treatment plan.
• Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes.
• Calculating and assigning appropriate reserves to claims, and managing reserve adequacy throughout the life of the claim.
• Managing claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
• Preparing required state filings within statutory limits.
• Providing information as needed for litigation or settlement negotiations