Claims Adjuster

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Job description

PRIMARY RESPONSIBILITIES

• Manages cases of employees injured on the job.
• Updates and maintains investigation reports, medical records, and case notes to determine compensability.
• Sets reserve levels, monitors claims costs, and generates payments to service providers and injured employees to cover injury related costs.
• Identifies and initiates subrogation activity to recover payment from at-fault third parties.
• Manages medical care including coordinating needed services and monitoring appointments.
• Negotiates claims within designated authority level.
• Testifies before the Workers' Compensation Commission on claims denials.
• Directs activities of Third Party Administrator and provides claims information to in-house legal counsel for mitigating the medical, indemnity, and legal costs associated with work-related injuries and illnesses.
• Analyzes claims and related documentation to determine liability exposure and to recommend proper course of action.
• Prepares comprehensive claims summary reports, settlement recommendations, and status reports to document claims cases.
• Performs other duties as might be assigned.

MANAGEMENT RESPONSIBILITIES

Reporting to this position are the following jobs:

Job Title

None

CHALLENGES

• Managing Third Party Administrator.
• Reducing Worker's Compensation claims costs.
• Handling multiple priorities.

EDUCATION/EXPERIENCE REQUIREMENTS

• Bachelor's degree in Human Resources, Business, or a related field, plus three (3) years of experience managing Illinois Worker's Compensation claims, including some experience working in a union environment and with a Third Party Administrator, or an equivalent combination of education and experience.

PHYSICAL REQUIREMENTS

• Requires remaining in a stationary position for extended periods of time and constantly operating a computer and other office productivity machinery.
• Service Area Requirement: Exempt (Non-Union) employees must live within the boundaries of the CTA Statutory Service Area either at the time of employment or within 6 months of beginning employment at CTA.

KNOWLEDGE, SKILLS, AND ABILITIES

• Detailed knowledge of Workers' Compensation industry standards and best practices.
• Working knowledge of the Illinois Workers' Compensation Act and the Illinois Workers' Compensation Commission.
• Working knowledge of related federal, state, and local laws and regulations.
• Working knowledge of the methods and practices in claims administration, case management, and cost containment solutions.
• Working knowledge of the practices and procedures of claims management including investigation and evaluation of claims.
• General knowledge of basic medical terminology related to the cause and treatment of occupational injuries and diseases.
• Knowledge of the Family Medical Leave Act and Short Term Disability processes.
• Strong verbal and written communication skills.
• Strong computer skills.
• Ability to collect and analyze facts and information.
• Ability to understand, interpret and follow laws, ordinances, regulations and procedures.
• Ability to establish and maintain effective working relationships with all levels of staff and the public.
• Ability to maintain strict confidentiality.

WORKING CONDITIONS

• General office environment.
• Occasional travel to various locations.

EQUIPMENT, TOOLS, AND MATERIALS UTILIZED

• Personal computer and related software (Microsoft Word, Power Point, Excel), HRIS, and claims software.

Employees and/or union members will be given priority consideration in the hiring process, per the applicable labor contracts.

Final salary will be determined in part by the qualifications of the selected candidate and may be higher or lower than target.

Applicants, if hired,must comply with CTA's residency ordinance.

CTA IS AN EQUAL OPPORTUNITY EMPLOYER

No employee or applicant for employment will be discriminated against because of race, color, creed, religion, sex, marital status, national origin, sexual orientation, ancestry, age, unfavorable military discharge, disability or any other status protected by federal, state, or local laws; except where a bona fide occupational qualification exists We are committed to providing an inclusive environment for our workforce and supporting the communities we serve. CTA will make reasonable accommodations for the known disabilities of otherwise qualified applicants for employment as well as its employees, unless undue hardship would result. If you require an accommodation in the application or hiring process, please contact prior to the submission of your application or upon notification of your actual test date. CTA will work with you to determine if an accommodation can be provided.

During the hiring process, CTA's Human Resources department will contact candidates with next steps . Failure to respond to these correspondences in a timely fashion may result in your application being closed out for non-responsiveness.

Please click link below to review the benefits offered at the CTA.

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