Rapid Resolution Claim Adjuster

Position Summary:

Reporting to the RRC Manager, the RRC Adjuster will be responsible for the full investigation, determination of acceptance/denial of the claim, appropriate reserving, medical management to include authorizations and coordination of referrals, if needed, and claims management to final closure on medical only claims.

Essential Duties & Responsibilities

• Comply with current RRC claim handling guidelines.
• Confirm the claim meets RRC criteria or identify the need to transfer to Core (next level claim handler).
• Complete initial 3-point contact investigation with clear documentation of findings.
• Ongoing communication throughout the life of the claim with the Member, employee, and medical providers.
• Promptly determine coverage and compensability for the claim.
• Clearly and timely document file with claim related decisions.
• Timely set and monitor reserves based on worst probable reserving guidelines.
• Maintain routine claim diaries to keep file moving towards file closure.
• Maintain regular contact with medical provider(s) to ensure that recommended medical treatment is promptly authorized.
• Utilize Signal vendor partners where contractually required and to mitigate claim costs, provide consistency in service delivery, and claim handling integrity for our Members and injured workers.
• Refer to internal SIU when investigative needs are identified. This includes initial investigation (adjuster must complete unless complications arise obtaining same), medical canvass, activity checks, background/social media checks, surveillance, or any other investigative needs.
• Perform other duties as required.

Required Education and Experience

• 3+ years relevant claims experience preferred
• Ability to multi-task and prioritize.
• Excellent verbal and written communication skills.
• Must be detail oriented and a self-starter with strong organizational abilities.
• Flexibility, accuracy, initiative and the ability to work with minimum supervision.
• Possess a strong customer service focus, be open to learning new tasks/training, and collaborate well in a team environment.
• The candidate should be proficient with computer systems, Microsoft Excel, Word, and Teams.

Job Type: Full-time

Pay: $50,000.00 - $58,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Family leave
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Education:

• Bachelor's (Preferred)

Experience:

• Claims: 3 years (Preferred)

Ability to Commute:

• Virginia Beach, VA 23452 (Required)

Work Location: In person