Senior Claim Adjuster - Vanderbilt University Medical Center
Nashville, TN
About the Job
Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of diverse individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and where your diversity of culture, thinking, learning, and leading is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research.
Organization:
RIM Work Comp
Job Summary:
JOB SUMMARY
Manages workers' compensation claims including investigation of claims, determination of compensability, and compliance with state regulations with minimal guidance.
.
KEY RESPONSIBILITIES
• Makes compensability recommendations for cases, including Interviewing employees, supervisors, treating physicians, and witnesses, as well as obtaining and reviewing sufficient information to determine compensability of claim.
• Secures case management and utilization review, coordinates medical care, manages communication between employee, supervisor, case manager and any other departments involved in the employee's injury.
• Manages expenses associated with claims.
• Establishes initial reserves on claim files.
• Ensures that all state reports are submitted accurately and in a timely fashion.
• Manages property, auto, and general liability claims
• The responsibilities listed are a general overview of the position and additional duties may be assigned.
TECHNICAL CAPABILITIES
• Customer Service (Novice): A continuing focus on the needs and requirements of customers, anticipating their needs, remaining sensitive to customers while performing services for them, responsive to customer needs.
• System Knowledge (Intermediate): Knowledge of the operation and support of the system from the standpoint of computer operations, network operations, and/or technical support.
• Workers Compensation (Intermediate): Knowledge about the Company's Workers Compensation insurance and benefits provided to employees who are injured or contract an occupational disease due to their employment.
• Computer Literacy (Intermediate): Knowledge of the use of applications and other tasks on computers as part of regular work responsibilities. It includes knowledge of personal computers utilizing software such as word processors, spreadsheets, text editors, and graphics.
Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.
At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.
Core Accountabilities:
* Organizational Impact: Performs non-routine tasks that significantly impact team's performance with minimal guidance. * Problem Solving/ Complexity of work: Conducts research and analysis to solve some non-routine problems.* Breadth of Knowledge: Applies broad job knowledge and has basic job skills in other areas.* Team Interaction: Provides informal guidance and support to less experienced team members.
Core Capabilities :
Supporting Colleagues: - Develops Self and Others: Continuously improves own skills by identifying development opportunities.- Builds and Maintains Relationships: Seeks to understand colleagues' priorities, working styles and develops relationships across areas. - Communicates Effectively: Openly shares information with others and communicates in a clear and courteous manner. Delivering Excellent Services: - Serves Others with Compassion: Invests time to understand the problems, needs of others and how to provide excellent service. - Solves Complex Problems: Seeks to understand issues, solves routine problems, and raises proper concerns in a timely manner. - Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support. Ensuring High Quality: - Performs Excellent Work: Checks work quality before delivery and asks relevant questions to meet quality standards.- Ensures Continuous Improvement: Shows eagerness to learn new knowledge, technologies, tools or systems and displays willingness to go above and beyond.- Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department. Managing Resources Effectively: - Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service. - Stewards Organizational Resources: Displays understanding of how personal actions will impact departmental resources. - Makes Data Driven Decisions: Uses accurate information and good decision making to consistently achieve results on time and without error. Fostering Innovation: - Generates New Ideas: Willingly proposes/accepts ideas or initiatives that will impact day-to-day operations by offering suggestions to enhance them. - Applies Technology: Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action. - Adapts to Change: Embraces changes by keeping an open mind to changing plans and incorporates change instructions into own area of work.
Position Qualifications:
Responsibilities:
Certifications:
Work Experience:
Relevant Work Experience
Experience Level:
3 years
Education:
High School Diploma or GED
Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and to the principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled
Organization:
RIM Work Comp
Job Summary:
JOB SUMMARY
Manages workers' compensation claims including investigation of claims, determination of compensability, and compliance with state regulations with minimal guidance.
.
KEY RESPONSIBILITIES
• Makes compensability recommendations for cases, including Interviewing employees, supervisors, treating physicians, and witnesses, as well as obtaining and reviewing sufficient information to determine compensability of claim.
• Secures case management and utilization review, coordinates medical care, manages communication between employee, supervisor, case manager and any other departments involved in the employee's injury.
• Manages expenses associated with claims.
• Establishes initial reserves on claim files.
• Ensures that all state reports are submitted accurately and in a timely fashion.
• Manages property, auto, and general liability claims
• The responsibilities listed are a general overview of the position and additional duties may be assigned.
TECHNICAL CAPABILITIES
• Customer Service (Novice): A continuing focus on the needs and requirements of customers, anticipating their needs, remaining sensitive to customers while performing services for them, responsive to customer needs.
• System Knowledge (Intermediate): Knowledge of the operation and support of the system from the standpoint of computer operations, network operations, and/or technical support.
• Workers Compensation (Intermediate): Knowledge about the Company's Workers Compensation insurance and benefits provided to employees who are injured or contract an occupational disease due to their employment.
• Computer Literacy (Intermediate): Knowledge of the use of applications and other tasks on computers as part of regular work responsibilities. It includes knowledge of personal computers utilizing software such as word processors, spreadsheets, text editors, and graphics.
Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.
At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.
Core Accountabilities:
* Organizational Impact: Performs non-routine tasks that significantly impact team's performance with minimal guidance. * Problem Solving/ Complexity of work: Conducts research and analysis to solve some non-routine problems.* Breadth of Knowledge: Applies broad job knowledge and has basic job skills in other areas.* Team Interaction: Provides informal guidance and support to less experienced team members.
Core Capabilities :
Supporting Colleagues: - Develops Self and Others: Continuously improves own skills by identifying development opportunities.- Builds and Maintains Relationships: Seeks to understand colleagues' priorities, working styles and develops relationships across areas. - Communicates Effectively: Openly shares information with others and communicates in a clear and courteous manner. Delivering Excellent Services: - Serves Others with Compassion: Invests time to understand the problems, needs of others and how to provide excellent service. - Solves Complex Problems: Seeks to understand issues, solves routine problems, and raises proper concerns in a timely manner. - Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support. Ensuring High Quality: - Performs Excellent Work: Checks work quality before delivery and asks relevant questions to meet quality standards.- Ensures Continuous Improvement: Shows eagerness to learn new knowledge, technologies, tools or systems and displays willingness to go above and beyond.- Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department. Managing Resources Effectively: - Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service. - Stewards Organizational Resources: Displays understanding of how personal actions will impact departmental resources. - Makes Data Driven Decisions: Uses accurate information and good decision making to consistently achieve results on time and without error. Fostering Innovation: - Generates New Ideas: Willingly proposes/accepts ideas or initiatives that will impact day-to-day operations by offering suggestions to enhance them. - Applies Technology: Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action. - Adapts to Change: Embraces changes by keeping an open mind to changing plans and incorporates change instructions into own area of work.
Position Qualifications:
Responsibilities:
Certifications:
Work Experience:
Relevant Work Experience
Experience Level:
3 years
Education:
High School Diploma or GED
Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and to the principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled
Source : Vanderbilt University Medical Center
