U.S. Concrete
  • 21-May-2018 to 20-Jul-2018 (CST)
  • Central Concrete Supply Co. Inc
  • San Jose, CA, USA
  • Salary
  • Full Time

Medical, Dental, Vision, 401k and more.


U.S. CONCRETE, INC.

RISK MANAGEMENT  - JOB DESCRIPTION

 

Revision Date: 08/20/2003

JOB TITLE:      Workman's Compensation Adjuster

 

 

PRINCIPAL FUNCTIONS

 

Manage the self-administered Workers' Compensation program in California.  Oversees Workers' Compensation claims administered by TPAs, RSKCo. and AIGCS. 

 

 

ORGANIZATION

 

Reports to:       Director of Safety & Risk Management

Supervises:       Adjusters

 

 

MAJOR JOB DUTIES, RESPONSIBILITIES and RELATED EXPERIENCE REQUIRED

 

 

  1. Review and evaluate all new claims/events set up in RiskMaster, determine if the initial reserve set by the adjuster is appropriate and approve the initial claims handling strategy.

 

  1. Oversee Workers' Compensation claims administered by Third Party Administrators, responsible for managing litigation, authorizing reserve increases, hiring nurse case managers and assigning defense council.

 

  1. Conducts quarterly Workers' Compensation claim reviews with TPA adjusters and include the Business Unit personnel to develop action plans to assist with expeditious and cost effective claim closure.

 

  1. Responsible for hiring new vendors and negotiating applicable rates. Review payments to vendors to ensure we are being charged at the correct negotiated rate.

 

  1. Assist adjusters with investigating claims, identifying fraudulent claims, developing defense strategies, identifying subrogation potential and total exposure analysis for accurate reserve establishment.

 

  1. Periodically review the accuracy of the accident description/cause codes, claim/event type codes and transaction type codes selected in order to maintain the accuracy/integrity of the data contained in RiskMaster.

 

  1. Manage claims in litigation including assigning defense counsel, assist in the development of defense strategies and with case development.

 

  1. Direct the administration of RiskMaster and train all the new staff on RiskMaster. Generates SortMaster reports upon request.  Provide monthly check register to the accounting department at US Concrete.

 

  1. Review all accident and injury investigation reports received by the Claims Department to ensure that the report is timely and the information contained on the report is detailed and is commensurate with the standard outlined in the Accident Investigation Standard Operating Procedure. If a report is substandard or late, an email is sent to the author of the report with enhancement recommendations and examples of stellar reports that can be used as examples.

 

  1. Represent US Concrete at legal proceedings as necessary.

 

  1. Review settlement evaluations submitted by adjusters and extend settlement authority as well as the initial offer amount.

 

  1. Review and approve all payments entered by adjusters. Release, print and electronically transmit checks to the bank.

 

  1. Review all open claims. Audit the paper files to ensure proper documentation is maintained to support claims payments and ensure each closed claim contains a signed/notarized release.

 

  1. Responsible for the identification, hiring and management of additional staff members as well as implementation of cost effective approaches to claims administration business processes.

 

  1. Review and approves all legal bills prior to payment entry.

 

  1. Provide daily support to the Business Unit personnel with questions relating to existing claims, new injuries or accident and reporting issues.

 

  1. Answer all Interrogatories.

 

  1. In the event of catastrophic injuries to one of our employees, intervene to facilitate communication between the TPA adjuster and the injured worker, expedite nurse case management assignment, ensure timely dispersement of benefits and assist the Business Unit personnel with information retrieval.

 

  1. Extract annual payment information for each vendor and print 1099's.

 

  1. Discuss all settlements in excess of $10,000 and all open claims quarterly with the Director of Safety and Risk Management.

 

 

QUALIFICATIONS

 

Degree in Business Administration or related field with a minimum of 5 years of claims adjusting experience.  Professional certifications such as Adjusters Licenses. Prior claims management experience in California required.  Excellent written, communication, software application, RMIS and interpersonal skills required. Advanced knowledge of Excel.

 

U.S. Concrete
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