Workers' Compensation Claims Adjuster

Duke University, United States

Updated: 20 days ago
Location: Durham, NORTH CAROLINA

Occupational Summary


Coordinate and administer a variety of activities associated with determining validity, assessing liability and risks, and negotiating monetary settlements for claims related to workers' compensation cases involving occupational illness or injury (including lost time and medical only claims).
 
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.
The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.
 
Required Qualifications at this Level
Education/Training:
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
Skills:
N/A
 
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
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.

North Carolina licensed adjuster for lost-time and medical workers’ compensation claims.  Current North Carolina licensure required.  

Duke University and Health System self-insures and self-administers its workers’ compensation program for approximately 44,000 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 and efficiently, consistent with best practices to achieve optimum outcomes.

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 on a constant basis, conduct prompt and thorough investigations, make sound compensability decisions and detailed 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, complete and file appropriate NCIC forms, and pay benefits and medical invoices timely. 

The ideal candidate will have a North Carolina adjuster’s license, with two to 10 years of workers’ compensation claims experience, and the desire to grow their expertise in a professional, collaborative environment.  I ndependent judgment and communication skills are essential.  The experience of the selected candidate will determine the seniority level of the position to be assigned.

Work is available onsite or remotely from North Carolina and certain approved states.  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.  Benefits at Duke | Human Resources


Knowledge, Skills and Abilities

N/A


Minimum Qualifications
Education

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


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 withassessment and settlement of claims. OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE. Valid North Carolina Claims Adjuster license also required.

Duke 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 essentialjob 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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