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CLAIMS SPECIALIST, SENIOR, WORKERS COMP

Job description


diversity employer



CLAIMS SPECIALIST, SENIOR, WORKERS COMP
Workers Compensation

Occupational Summary

Senior adjuster for lost-time and medical claims. Current North Carolina licensure required.

Duke University and Health System self-insures and self-administers its workers' compensation program for approximately 38,000 employees in a tremendous variety of jobs. Our Workers' Compensation department is proud to serve our injured Duke coworkers by managing their work-related injury claims fairly, efficiently, and promptly. Our administrative systems and low claim counts afford each adjuster the opportunity to provide individualized service to every injured worker.
Our licensed claims adjusters are expected to communicate effectively with the injured worker and supervisor, conduct prompt and thorough investigations, make sound compensability decisions and settlement recommendations, authorize and coordinate appropriate medical treatment, coordinate pre- and post-MMI return to work, effectively utilize and communicate with attorneys and rehab professionals, and pay benefits and medical invoices timely. Independent judgment is a must, so that each adjuster can contribute to our collaborative, team approach to achieve outcomes consistent with best practices. We believe that good outcomes are shared by the injured worker and Duke.

Duke University offers competitive pay and a comprehensive benefits package, as well as the opportunity to work for one of the area's premier employers in a highly professional and friendly work environment. http://www.hr.duke.edu/benefits/index.php

Work Performed
  • Investigate claims through direct contact with employees, supervisors and other witnesses as appropriate to collect information regarding incidents; explain process to claimant; collect data from Employee Occupational Health Services; determine if case is compensable; interact with various external persons such as insurance adjusters, attorneys, physicians and other parties to coordinate the mediation, settlement and processing of claims; document findings.
  • Establish and adjust claims reserves as required to comply with appropriate regulations. Negotiate settlement for cases falling within established guidelines; make recommendations on cases not settled through negotiation; assist the legal counsel in the preparation of materials and evidence for use in North Carolina Commission hearings.
  • Compile information regarding incidents and related medical expenses, and prepare ongoing reports as required by state law and established departmental procedures; submit reports to the North Carolina Industrial Commission by designated deadlines.
  • Coordinate with nurse case manager and vocational rehabilitation professionals, as appropriate, to assist employees in the return to work. Participate in internal and external conferences or other groups to keep abreast of current developments in safety techniques, methods and programs and the North Carolina Industrial Commission and Compensation Act.

Perform other related duties incidental to the work described herein.


Requisition Number
401380140

Location
Durham

Duke Entity
CENTRAL ADMIN MANAGEMENT CTR

Job Code
2384 CLAIMS SPECIALIST, SENIOR, WORKERS COMP

Job Family Level
13

Exempt/Non-Exempt
Exempt

Full Time / Part Time
FULL TIME

Regular / Temporary
Regular

Shift
First/Day

Minimum Qualifications
Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

Education

Work requires a communications, analytical and organizational skills generally acquired through the completion of a bachelor's degree program.

Experience

Work generally requires 3 years of experience in insurance, a safety-related position such as workers' compensation claims adjuster, commercial casualty claims adjuster, insurance investigator, safety officer, or related occupation to gain knowledge of insurance claims experience and to acquire skills necessary to coordinate a variety of activities associated with assessment and settlement of claims. Valid North Carolina Claims Adjuster license also required. OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE

Auto req ID

97460BR

Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, genetic information, gender, gender expression, gender identity, national origin, race, religion, sexual orientation, or veteran status.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

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Job No:
Posted: 5/10/2018
Application Due: 5/25/2018
Work Type:
Salary: