Senior Workers' Compensation Claims Adjuster

Position Summary

We are recruiting for an experienced Senior Workers' Compensation Claims Adjuster to manage complex workers' compensation indemnity claims from inception through resolution.

This position requires an experienced claims professional who can independently manage complex claims, conduct investigations, determine compensability, administer benefits, and work closely with clients, claimants, medical providers, defense counsel, and other claims professionals.

Key Responsibilities

• Independently manage an average caseload of approximately 130 workers' compensation claims, including highly complex indemnity claims.

• Initiate and conduct timely claims investigations.

• Determine compensability and administer benefits in accordance with applicable state laws and established claims handling guidelines.

• Develop and execute claim action plans to ensure appropriate and timely resolution.

• Manage medical treatment and medical billing, including authorizations as appropriate.

• Calculate and administer indemnity benefits and approve claims payments within established authority.

• Refer claims to outside defense counsel and manage litigation activities as appropriate.

• Manage claims recoveries, including deductibles and subrogation.

• Communicate effectively with clients, claimants, medical providers, and vendors regarding claims issues.

• Establish and maintain accurate claims reserves in accordance with established guidelines.

• Negotiate settlements, finalize claims, and obtain appropriate settlement authority.

• Maintain accurate and timely claim documentation, diary systems, and file reviews.

• Keep clients informed of significant claims developments, injury trends, and potential safety concerns.

• Conduct independent claim file reviews to ensure compliance with claims handling standards.

• Follow established policies, procedures, and regulatory requirements.

Required Qualifications

• Five (5) or more years of workers' compensation claims handling experience, or an equivalent combination of education and experience.

• Demonstrated experience independently managing complex workers' compensation indemnity claims.

• Strong technical knowledge of applicable workers' compensation statutes, regulations, and medical terminology.

• Experience investigating claims, determining compensability, managing reserves, and negotiating settlements.

• Strong analytical, organizational, and problem-solving skills.

• Excellent written and verbal communication skills.

• Ability to communicate effectively with claimants, clients, attorneys, medical providers, and internal claims teams.

• Ability to manage multiple priorities and maintain accurate claim documentation.

• Applicable claims adjuster licenses and/or certifications as required by state regulations.

Preferred Qualifications

• Bachelor's degree in a related field.

• Experience handling workers' compensation claims for self-insured employers.

• Public entity claims experience, including city, county, and/or school district accounts.

• Proficiency in Microsoft Word and Excel.

Ideal Candidate

The ideal candidate is an experienced workers' compensation claims professional who is comfortable managing complex indemnity claims independently, maintaining strong client relationships, and working toward timely, cost-effective claim resolutions while ensuring compliance with applicable regulations.