Claim Adjuster

Working at RCM&D and SISCO is ideal for those seeking a challenging, rewarding and upwardly mobile career in risk management, insurance and employee benefits. Dedicated to fostering their continued success and growth, we are deeply invested in our employees.

Job Summary:

Investigate and manage all aspects of Workers’ Compensation claims, primarily in Maryland, in accordance with jurisdictional requirements to the best possible resolution.

Essential Functions:

• Review, examine, investigate, and analyze indemnity workers’ compensation claims.
• Interact with injured employers to ensure awareness and understanding of the workers’ compensation process, requirements, and entitlements.
• Investigate compensability issues, including taking recorded statements.
• Determine compensability of workers’ compensation claims.
• Coordinate medical treatment for injured employees and provide information to treating physicians regarding employee’s medical history, health issues, and job requirements.
• Serve as a liaison between medical providers, employees, and employer departments; and inform departments of an injured employee’s work restrictions and coordinate appropriate accommodations.
• Review and interpret doctor’s reports to ensure that the appropriate American Medical Association (AMA) guidelines have been applied.
• Communicate with defense attorneys regarding litigated cases; make recommendations regarding proposed strategies for claim resolution.
• File appropriate jurisdictional forms.
• Calculate and issue indemnity payments.
• Approve medical payments timely on assigned claims.
• Monitor medical treatment on assigned claims.
• Provide proactive claim management, including documenting plans of action for moving claims toward closure.
• Assign Nurse Case Managers and Vocational specialists, when appropriate.
• Issue denial letters to providers and claimants, when appropriate.
• Communicate status reports to employer and excess carriers.
• Make recommendations regarding claim handling and resolution.
• Reserve claims based on most probable outcome.
• Maintain a diary on all open claims.
• Attend hearings, trials, and mediations, when appropriate.
• Prepare claim summaries and attend quarterly claim review meetings with employers.
• Monitor hearing date, consideration date logs and timely payments of WCC Awards.
• Develop and maintain professional relationships with assigned clients through timely communication to client.
• Adhere to SISCO standards and procedures.
• Document claim activity in claim processing system, Spear.
• Additional duties as assigned.

Minimum Education/Abilities/Skills:

• High school diploma or GED; some college preferred.
• Possess 1+ years’ experience performing the duties of this position or one with similar requirements.
• Excellent written and oral communication skills are necessary
• Must possess strong interpersonal skills and is able to work collaboratively and professionally with internal and external stakeholders; able to work independently or in concert with the team.
• Maintain a client-centric focus.
• Must possess solid organizational skills, prioritization skills, and a strong attention to detail.
• Exhibit strong time management skills; possess the ability to work under pressure and meet deadlines and deliverables. 
• Adept at interpreting data and information.
• Demonstrates a willingness to learn.
• Contribute to team efficiency by sharing knowledge and best practices.
• Able to deal with change and ambiguity.
• Demonstrate agility and the ability to multi-task, as well as pivot to changing priorities, as circumstances warrant.
• Must be proficient with Microsoft Office Suite, and experience with claim management software is a plus.

Finding and cultivating talent is a hallmark of our organization. RCM&D looks for the best and brightest risk management, insurance and employee benefits professionals to join our firm. As a growing and vibrant business, we also recruit savvy marketing, sales, finance, human resources, technology and administrative colleagues to manage and operate our business.