Workers Comp Adjuster I or II

JOB SUMMARYA variety of soft skills and experience may be required for the following role Please ensure you check the overview below carefully.The purpose of this position is to perform a variety of professional duties in support of the Southern Company Gas Workers' Compensation program including reviewing claims documentation for compensability and subrogation issues; reviewing medical records and invoices for payment approvals; filing State Board forms; computing indemnity benefits and relevant payments; providing information and assistance to the Director of Claims, injured employees, Claims Manager, Legal Department, business units, medical and legal professionals, excess carriers; and performing related duties as assigned. This position is for more experienced worker's compensation adjusters.This position may be filled as Workers Comp Adjuster I or II. Individuals who demonstrate advanced skills in terms of work experience, education, and certifications may be eligible for the more advanced position.This position follows a hybrid work schedule. Employees are required to be in the office three (3) days per week.This position could work out of the Atlanta, GA or Naperville, IL office.JOB RESPONSIBILITIES & ACCOUNTABILITIES BY COMPETENCYFunctional Expertise:Manage all workers' compensation claims in accordance with state law while utilizing all cost containment strategies necessary to effectuate the most cost-effective outcomes.Conduct claims investigations to determine compensability.Maintain contact with injured employees, medical providers, and appropriate business units to facilitate return to work.Monitor all medical reports and treatment plans and set reserves accordingly.Maintain all files in compliance with current Medicare reporting and all other state and federal regulations.Maintain a high level of communication with all business units having injured workers.Make timely benefits payments on all workers' compensation claims.Maintain reporting standards and present case reviews to roundtable panels as well as internal clients as required.Manage all claims in accordance with both industry and company best practices.Prepare settlement evaluations for supervisor review and authority.Provide legal counsel with pertinent documents and case summary information to coordinate defense of litigated cases.Participate and attend testimony at hearings, mediations, conferences, and other formal meetings as required.Participate in quarterly case reviews and manage activities of outside defense counsel.Serve as backup to disability specialist.Handle more complex worker's compensation issues.Business Acumen:Coordinate and develop plans with medical providers, nurse case managers, and business units to return employees to work at the earliest medically appropriate time including using a transitional work duty period, if required.Prepare comprehensive evaluations for serious/long-term cases and recommend reserves at the estimated ultimate settlement value.Review each case for all offset opportunities including second injury funds, subrogation, Social Security, and other reimbursements.Actively pursue subrogation and second injury fund recoveries.Engagement:Coordinate all claims management and return to work efforts with the nurse and business unit management.Participate in regular reviews of pending claims and return to work strategies with Workers' Compensation Coordinator, Risk Management Managing Attorney, and employee's management.Track loss experience, identify and report trends and underlying safety issues to Workers' Compensation Coordinator, Risk Management Managing Attorney, Disability Management, and the Safety & Health Department.Extensive communications with all injured employees to educate, inform, and assist as needed.Driving Results:Utilize Best Practices to control medical, litigation, and outside service expenses.Adhere to Best Practices service standards and fully document all claims activity in claims operating system.WORKERS COMP ADJUSTER I REQUIREMENTSEducation, Certifications/Licenses:Bachelor's DegreeWorkers Compensation Adjuster LicensePreferred:Associate In Claims (AIC)Related Work Experience:Minimum 1 year of experience handling workers' compensation indemnity claims of medium complexity/severitySpecific Skills & Knowledge:Demonstration of analytical thinking in complex situations and recognition of multiple connections to reach appropriate case decisions.Excellent interpersonal, oral, and written communication skills.Must evidence a strong and seasoned ability to strategize, prioritize, and negotiate; demonstrates confident decisiveness and sound judgment.Customer focused and approachable with a high level of comfort in dealing with all levels of management.Able to problem solve and make timely decisions.Team-oriented, able to work in a team environment.Goal oriented.Accountable for work product.Able to handle complex claims from inception through to a hearing or settlement when necessary.Maintains Quality and Dedicated to Excellence.Willing to continue education to keep apprised of latest industry trends and statutory laws.Proficient with Microsoft Excel, Word, Risk Master Accelerator, and willing to learn new claim management and reporting systems.WORKERS COMP ADJUSTER II REQUIREMENTSEducation, Certifications/Licenses:Bachelor's DegreeWorkers Compensation Adjuster LicensePreferred:Associate In Claims (AIC)WCCP CertificationRelated Work Experience:Minimum 3 years of experience handling workers' compensation indemnity claims of medium complexity/severitySpecific Skills & Knowledge:Demonstration of analytical thinking in complex situations and recognition of multiple connections to reach appropriate case decisions.Excellent interpersonal, oral, and written communication skills.Must evidence a strong and seasoned ability to strategize, prioritize, and negotiate; demonstrates confident decisiveness and sound judgment.Customer focused and approachable with a high level of comfort in dealing with all levels of management.Able to problem solve and make timely decisions.Team-oriented, able to work in a team environment.Goal oriented.Accountable for work product.Able to handle complex claims from inception through to a hearing or settlement when necessary.Maintains Quality and Dedicated to Excellence.Willing to continue education to keep apprised of latest industry trends and statutory laws.Proficient with Microsoft Excel, Word, Risk Master Accelerator, and willing to learn new claim management and reporting systems.Working Conditions/Physical Requirements:Keyboarding = Constant 67-100%Travel = Occasional 1-33%On-call = NoneAbout Southern Company GasSouthern Company Gas is a wholly owned subsidiary of Atlanta-based Southern Company (NYSE:SO), America's premier energy company. Southern Company Gas serves approximately 4.2 million natural gas utility customers through its regulated distribution companies in four states and approximately 600,000 retail customers through its companies that market natural gas. Other nonutility businesses include investments in interstate pipelines and ownership and operation of natural gas storage facilities. For more information, visit .Southern Company (NYSE: SO) is a leading energy provider serving 9 million residential and commercial customers across the Southeast and beyond through its family of companies. Providing clean, safe, reliable, and affordable energy with excellent service is our mission. The company has electric operating companies in three states, natural gas distribution companies in four states, a competitive generation company, a leading distributed energy infrastructure company with national capabilities, a fiber optics network, and telecommunications services. Through an industry-leading commitment to innovation, resilience, and sustainability, we are taking action to meet our customers' and communities' needs while advancing our commitment to net zero emissions by 2050. Our uncompromising values ensure we put the needs of those we serve at the center of everything we do and are the key to our sustained success. We are transforming energy into economic, environmental, and social progress for tomorrow. Our corporate culture and hiring practices have earned the company national awards and recognition from numerous organizations, including Forbes, Military Times, DiversityInc, Black Enterprise, J.D. Power, Fortune, Human Rights Campaign, and more. To learn more, visit .Southern Company is an equal opportunity employer where an applicant's qualifications are considered without regard to race, color, religion, sex, national origin, age, disability, veteran status, genetic information, sexual orientation, gender identity or expression, or any other basis prohibited by law.Job Identification: 8027Job Category: Legal & ComplianceJob Schedule: Full timeCompany: AGL Services Company#J-18808-Ljbffr

Created: 2024-10-29