Insurance Analyst II (Insurance Adjuster I) - 60025537

Full Job Description

The mission of the South Carolina State Accident Fund is to provide cost-effective, guaranteed workers’ compensation insurance for state agencies and other governmental entities along with exceptional service to our state workers.

Are you looking for new opportunities to further your career? Ever thought about a career in state government but weren't sure where to start? If so, look no further than the South Carolina State Accident Fund. We are seeking hardworking and dependable candidates just like you to apply!

The South Carolina State Accident Fund (SAF) is the leading provider of workers' compensation insurance in South Carolina.

Since 1943, the State Accident Fund has provided a continuous guaranteed source of cost-effective workers' compensation coverage.

Today we serve nearly 600 employers and 200,000 state and local government employees throughout the state.

Within the State Accident Fund, the Uninsured Employers Fund (UEF) administers benefits as determined by the SC Workers' Compensation Commission for employers who fail to secure proper workers' compensation coverage for their businesses.

The Claims Adjuster I, acting as a member of the Saluda Claims Team with guidance from the Saluda Claims Team Supervisor, will:

• Provide workers’ compensation benefits to injured workers and assist injured workers, policyholders, medical providers, attorney’s and other stakeholders.
• Records all accepted or denied body parts, lost time and/or return to work dates.
• Determines compensability of claims and monitors all lost time periods substantiated by reviewing medical documentation and authorizes income replacement as appropriate.
• Authorizes and submits medical payments and lost time payments in accordance with the SC Workers' Compensation Law.
• Files all workers’ compensation forms timely and accurately in accordance with the SC Workers’ Compensation Law.
• With the guidance of the Claims Manager (CM), monitors all claims in accordance with agency policy and procedures as outlined in the Claims Training Manual.
• Performs a monthly claims review and a plan of action for all assigned claims and attends Claims Review Team meetings as necessary.
• Recommend vocational rehabilitation or special medical management referrals.
• Attend depositions, mediations, hearings, clincher conferences and informal conferences before the Workers' Compensation Commission, when necessary.
• Reviews cases with the CM and obtains authority for settlements following recommendations from the policyholder.
• With guidance from the CM, negotiate settlements with claimant or attorney and prepares all necessary settlement documents/forms.
• Review and monitor all reserves throughout the duration of claims and consult with CM.
• With the assistance of legal counsel, interpret Workers' Compensation Commission orders.
• Handles special projects and performs other duties as may be required and/or assigned.

THIS POSITION MAY REQUIRE OCCASIONAL IN-STATE TRAVEL.

Requirements

• A Bachelor’s Degree.
• Applicants not meeting the State’s minimum requirements are encouraged to apply and may be considered pending approval of an acceptable equivalent combination of education and experience in accordance with State Human Resources Regulations.

Must possess or be able to obtain a valid South Carolina Insurance Adjuster’s License within twelve (12) months of the start of employment.

Qualifications

• Experience and/or knowledge in customer service, data entry, paralegal services, medical terminology, medical billing and/or coding, responding to telephone and email inquiries, and/or working with confidential information.
• Experience and/or knowledge handling/adjusting/examining workers’ compensation claims or insurance claims.
• Experience and/or knowledge of workers’ compensation laws, rules and regulations, insurance practices and procedures, medical terminology, costs of medical treatment, and/or methods and techniques for determining compensable wages.
• Experience and/or knowledge of office practices, policies, procedures, rules, regulations and equipment.
• Ability to establish and maintain effective working relationships and work independently as well as a member of a team as needed.
• Possesses the ability to communicate effectively both orally and in writing.

Additional Information

The State Accident Fund is committed to providing equal employment opportunities to all applicants and does not

discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions

including, but not limited to, lactation), national origin, age (40 or older), disability or genetic information.

DISCOVER YOUR WORKLIFE BALANCE!

The State Accident Fund offers an exceptional benefits package for full-time (FTE) employees:

• Health, dental, vision, long-term disability, and life insurance for employees, the employee’s spouse, and children;
• 15 days* of annual (vacation) leave per year;
• 15 days of sick leave per year;
• 13 paid holidays;
• Employee Assistance Program: Up to 5 counseling sessions annually for employees and eligible household members, Up to 5 Life Management Services (i.e., legal, financial, child/elder/pet care), and Unlimited assessment and referral services;
• Paid Parental Leave;
• State Retirement Plan and Deferred Compensation Programs;
• Hybrid telecommuting schedules**; and
• Public Service Loan Forgiveness.

*Employees in FTE status earn additional annual leave the longer they remain employed with the state.

**Eligibility to work remotely requires successfully completing a period of employment with the agency.

A copy of your transcript may be uploaded as an attachment to the application. Upon hiring, candidates must submit

official college transcript(s) or diploma(s) for degree(s) obtained. Failure to produce an official, certified transcript may

result in not being hired or termination.