Job Description
At Ports America, the Claims Adjuster will determine compensability or denial and settle or authorize payments to routine USLH personal injury (USLH) and cargo/liability claims.
Essential Duties: - Work independently to adjust claim files within authority limits up to $50,000 in exposure.
- Receive claim notices, establish claim files, input data, investigate claims, maintain, and update claims filings.
- Responsible for timely reporting to USDOL and other entities requiring filing of first reports and other notifications.
- While the position is primarily responsible for adjusting of USL&H claim files there may be some involvement in liability and cargo damage claims
- Manage all aspects of claims through completion of claim files for all coverages and exposures.
- Strategic claims management towards negotiation of claims resolution
- Research and information gathering regarding claims, ability to gather data, compile information, and prepare reports.
- Decision making to set appropriate reserves for medical only and lost time claims and set up in the claims system.
- Review and interpret medical and legal reports to guide decision making on file direction and strategy within authority limits.
- Complete necessary reporting and filing of all forms in compliance with statutory and timeliness requirements.
- Establish and approve appropriate medical treatment for workers' compensation claims.
- Wage investigation, initiate bi-weekly compensation payments, manage and track those on comp.
- Handle written and verbal correspondence and communication with claimants, Dept. of Labor, physicians, and attorneys.
- Under the direction of Claims Manager, arrange for legal representation and assist in preparation of defense.
- Review and approve medical bills, assist in the audit of bills to determine reasonableness.
- Input payments and provide appropriate support for all payment requests.
- Ensure accurate payment data for each weekly check run with review of batch edit reports.
- Handle status request for unpaid medical bills from medical service providers
- Provide Safety Dept. with necessary information and reports concerning number and type of accidents, to include OSHA 300
- Manage MMSEA data for claim files and ensure accurate reporting to CMS through claim system.
- Ongoing communication with operations and HSE in management of claims
- Attendance at operations and safety meetings and present claims background as appropriate.
- Maintain up to date claim diaries and notes within claims management system.
- Direct and manage claims admins in support of claims process.
- Available off hours for accidents reported as serious.
- Other duties as assigned.
Minimum Qualifications: - Bachelor's Degree in any discipline
- Equivalent experience and education may be considered.
- 3+ years of claims office experience
- 5+ years Longshore or Maritime claims administration or related insurance industry experience
Preferred Qualifications: - Excellent computer skills including all Microsoft Office suite with intermediate Excel and Word
- Excellent communication skills
- Well organized, attention to detail
- Ability to work efficiently and resourcefully with minimal supervision.
NOTE: This job description is not intended to be all-inclusive. Employees may perform other related duties as needed to meet the ongoing needs of the organization.
Ports America is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race; color; religion; national origin; sex (including pregnancy); sexual orientation; gender identity and/or expression; age; disability; genetic information, citizenship status; military service obligations or any other category protected by applicable federal, state, or local law.
This role does not offer sponsorship for work authorization. External applicants must be eligible to work in the US.
If you require additional information about our comprehensive data privacy policy ( Employee Compliance Notice.pdf), we invite you to contact us via email at human.resources@portsamerica.com. Our dedicated team at Ports America will be pleased to address any specific inquiries or concerns you may have regarding the handling, protection, and security of your data. We are committed to ensuring the utmost privacy and confidentiality of your personal information and will gladly provide you with the necessary details to help you better understand our practices and protocols.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
Job Tags
Weekly pay, For contractors, Local area,