Claims Adjuster Medical Only (Remote)

CopperPoint Insurance Company has an exciting opportunity for a Claims Adjuster, Medical Only in Nevada. This position is responsible for analyzing reported medical-only workers’ compensation claims to determine compensability and process medical benefits due to ensure adjudication of claims within company standards and in compliance with regulatory agency requirements. The candidate must reside in Nevada or have a Nevada adjuster’s license. T

Job responsibilities:

• Analyze and investigate medical only claims to determine compensability decisions by interpreting and applying laws, rules, and regulations of workers’ compensation.
• Monitor injured workers’ work status to ensure timely conversion to indemnity adjuster. Utilize all available resources as appropriate.
• Pro-actively manage claims in accordance with company standards and statutory requirements. Establish and maintain cost drivers and data elements to ensure accurate state regulatory and Medicare reporting.
• Build and maintain professional customer relationships while communicating claim action with customer. Appropriately document communications and claim management activities.
• Ensure timely payment of medical benefits. Actively utilize all available cost containment measures and programs i.e. subrogation, and vendors.
• Recognize and address coverage issues and potential fraud and subrogation.
• Completes special projects as assigned by manager and performs other duties as assigned.

Qualifications/Competencies:

• Bachelor’s degree (B. S. or B.A.) in business administration, communications, or a related field from an accredited four-year college or university, and a minimum 2 years related experience in insurance claims operations.
• Minimum 4+ years of full-time work experience in commercial insurance can be utilized on a year for year basis as a substitute for a degree.
• Certifications are preferred, not necessary.
• Good technical claims knowledge with prior successful experience in a workers’ compensation as well as other commercial lines claims management environment.
• Knowledge of Department of Insurance (DOI), National Council on Compensation Insurance (NCCI) and state specific regulatory rules and regulations.
• Ability to analyze, interpret and apply laws, rules and regulations pertaining to workers’ compensation.
• Ability to stay current with changes to statutory, industry rules and regulations as well as company policies and procedures which may impact claims management.
• Ability to set priorities, manage time, organize work and meet deadlines.
• Excellent customer service skills to include initiative, mature judgement and discretion.

Salary Range:

• $40,000.00 – $55,000.00 annually
• Compensation may vary depending on skills, experience, education, and geographical location.
• In addition to base salary, compensation may include an annual discretionary bonus.

Benefits:

• Employees and their families are eligible to participate in CopperPoint Insurance Companies benefit plans including medical, dental, vision, short-term disability, long-term disability, life insurance, a health savings account, a flexible spending account, and a 401k plan.
• We provide some benefits at no cost to the employee (Basic Life Insurance and AD&D at two times an employee’s annual salary, Short- and Long-term Disability coverage, and Employee Assistance Plan).
• Employees will accrue 0.0692 hours of Paid Time Off (PTO) per paid hour, which may total 18 days a year. In addition, employees will also receive 10 paid holidays throughout the calendar year.

Founded in 1925, CopperPoint Insurance Companies is a leading provider of workers’ compensation and commercial insurance solutions. With an expanded Line of insurance products and a growing ten-state footprint in the western United States, CopperPoint embodies stability for policyholders in Alaska, Arizona, California, Colorado, Idaho, Nevada, New Mexico, Oregon, Utah, and Washington. CopperPoint Mutual Insurance Holding Company is the corporate parent of Arizona-based CopperPoint Insurance Companies, California-based Pacific Compensation Insurance Company, Alaska National Insurance Company, and other CopperPoint Insurance Entities.

CopperPoint’s culture of compassion extends to the community through employee volunteerism, corporate matching, Board service, program sponsorships and in-kind contributions. We empower employees by providing 12-hours of paid volunteer time annually and matching their personal contribution to the charities of their choice up to $500 per year. In 2019, CopperPoint employees reported 3,500 volunteer hours.

CopperPoint offers a competitive compensation package and comprehensive benefits package including major medical, dental, vision and a wide range of competitive benefits programs, generous matching contributions to your 401(k) plan, generous paid time off, tuition reimbursement and other education benefits and business casual dress. CopperPoint is an equal employment opportunity employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status or any other characteristic protected by state, federal or local law. CopperPoint maintains a drug-free workplace.