Defense Base Act Workers' Compensation Adjuster

About Us

• Manage assigned caseload of workers’ compensation claims.
• Make decisions about compensability, set reserves and negotiate settlements.
• Assigns, when necessary, appropriate vocational rehabilitation for the purposes of a labor market survey.
• Coordinates, when necessary, light duty accommodation with AAFES’ Human Resources Center.
• Determines whether an injured worker is a Medicare beneficiary or possibly receiving SSDI benefits and assigns, when necessary, a Medicare Set-Aside to CCS Medicare Services.
• Interact with claimants, clients, attorneys, representatives of the U.S. Department of Labor, medical providers and other third-party representatives throughout the claims process.
• Assess worst probable exposure and apply appropriate reserving practices.
• Timely initial contacts and investigation of new claims.
• Prepares reports and other analytical data as requested by the management team.
• Independently identify and resolve most common claim file issues.
• Prepare for and/or represent the Employer at Informal Conferences.
• Adjust extent of disability claims to include Labor Market Surveys and Loss of Wage-Earning Capacity (LWEC) calculations.
• Accurately calculate present value of LWEC claims and prepare settlement memos/analysis.
• Negotiate settlements.
• Adjust claims requiring Medicare Set-Aside Arrangements (MSAs).
• Adjust claims involving S33 subrogation.
• Adjust claims involving S8(f).
• Verify coverage.
• Take recorded statements as needed.
• Document files as necessary on conversation and actions taken.
• Identify and address subrogation issues.
• Administer benefits timely and accurately.
• Complete jurisdictional forms timely and accurately.
• Monitor ongoing medical treatment.
• Request second medical opinions as needed.
• Request surveillance appropriately.
• Work mail and diary on a daily basis.

• Client visits as required.
• Preparation of documents for informal conferences and formal hearings; participate in the
• proceedings at client discretion.
• Communicates directly with the client.

• Must have at least 2-3 years of experience handling indemnity workers’ compensation claims for DBA.
• High school diploma.
• Ability to follow instructions, procedures, and rules.
• Must have strong attention to detail.
• Must have good written and oral communication skills.
• Must be well organized and the ability to multi-task.
• Basic computer skills in MS Word, Excel and Outlook.
• Fast, accurate data entry

• College degree in business or other related discipline.

• Proficient in MS Office.
• Consistently completes timely investigation depending on claim type and makes timely compensability determinations.
• Consistently makes timely and accurate LS form filings as well as Indemnity/Medical payments.
• Consistently reviews and establishes appropriate reserves and documents rationale.
• Demonstrates the ability to consistently and concisely document Vista claim notes with pertinent information, to include a plan of action.
• Demonstrates good time management skills, to include timely completion of claim file diaries, Image Right tasks and organization.
• Consistently adheres to all Company and account specific policies and procedures.
• Consistently ensures all claim file coding is accurate/current.
• Ability to communicate effectively, in both oral and written forms of communication.
• Ability to work in a fast-paced environment.
• High level of accuracy and attention to detail.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to calculate benefits in accordance with applicable law