UnitedHealth Group
Workers Compensation Claims Adjuster - US Telecommute
At a glance
Location: US-FL-Tampa Map
Posted: 09/30/2019
Closing: 10/29/2019
Degree: Not Specified
Type: Full-Time
Experience: Not Specified
UnitedHealth Group
Job description

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.


Primary Responsibilities:

  • Adjudicate assigned claims according to state regulation and corporate Best Practice Guidelines
  • Assist in developing and recommending claim strategy
  • Claims may be assigned from any of Risk Management - supported lines of business
  • Position is assigned active open indemnity claims
  • Claims are commonly more active in nature – involving time lost from work, interaction with client contacts, and frequent Workers’ Compensation Board interaction
  • Will regularly require check - in regarding medical treatment status, return to work status, job search activity, settlement interest, and Medicare coordination of benefits (MSP Section 111 claims reporting)
  • Adjudicate and manage more complex, higher dollar Workers’ Compensation claims in an independent manner according to state regulations and corporate standards, including but not limited to
  • Receive report and conduct initial intake via contact with appropriate parties, including but not limited to employer, claimant, and medical providers. Expand contacts to include defense counsel with disputed claims
  • Conduct ongoing review and referral of submitted reports and documentation for reasonableness and completeness, including but not limited to compensability assessments and controversy reviews
  • Frequent review for possible fraud; coordinate with Fraud Inspector General’s Office, state and local agencies, and / or appropriate third parties as necessary
  • Ensure all necessary documentation is completed and submitted on an ongoing basis to appropriate parties and to RMIS claim notes, including but not limited to claim summaries (plans of action)
  • Maintain ongoing contact with interested parties, including attorneys for hearing purposes, settlements, case appeals, and other claim actions
  • Set reserves and adjustments, ensure justification is well documented to claim file and shared with clients as per Special Handling Guidelines
  • Prepare claim payments and offsets for authorized expenditures, including biweekly indemnity payments per RMIS scheduling system (autopay)
  • Report, and update claims as appropriate per clients’ excess insurance policy reporting requirements
  • Seek timely reimbursement from third parties, including but not limited to Second Injury Fund, Fund for Reopened Cases, excess insurance carriers, and third party liability settlement
  • Prepare claims updates as required by Medicare (claims flagged for reporting) for coordination of benefits under MSP Section 111 standards.
  • Prepare claims updates as required by Self Insurance office for annual reporting purposes
  • Primary party charged with developing and recommending claim strategy as appropriate to internal and external parties
  • Attendance at periodic off-site meetings, including but not limited to client meetings, conferences, and training programs, as requested
  • Additional tasks and projects as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • High School Diploma / GED (or higher)
  • 2+ years experience handling worker’s compensation incidents/injuries on the job, involving lost time and medical treatment
  • Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals
  • Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages
  • Ability to apply concepts of basic algebra and geometry
  • NYS General Municipal Law 207A & C knowledge and / or experience
  • Ability to travel up to 10% Once every three months to a clients location or seminar, and may require over night stay
  • New York State license as an independent claims adjuster or ability to obtain within 6 months of hire
  • Ability to work Monday through Friday 7 am to 5 pm EST

Soft Skills:

  • Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public
  • Ability to deal with problems involving several concrete variables in standardized situations
  • Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form
  • Ability to follow through on deadlines imposed by self, Supervisor, regulatory agency, and / or client
  • Ability to read and interpret documents such as procedure manuals
  • Ability to write reports and business correspondence
  • Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public
  • Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures or governmental regulations

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.


UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, Telecommute, Workers Compensation, Claims

Workers Compensation Claims Adjuster - US Telecommute