Job Description

The Claims Adjuster will manage workers' compensation claims, ensuring quality file management and a leading customer experience by adhering to best practices and regulatory requirements. Responsibilities include claim investigation, compensability decisions, reserve management, benefit administration, and legal activity control. The role involves customer service, collaboration with partners, and continuous improvement of claims operations.

Responsibilities

• Handle all aspects of workers’ compensation claims from set-up to closure
• Conduct timely 3-point contact investigation
• Mitigate claim exposure
• Determine compensability decisions
• Set and adjust reserves
• Administer medical and indemnity benefits
• Comply with guidelines and regulations
• Control legal activity
• Prioritize early resolution opportunities
• Serve as a point of contact for agents and customers
• Provide claim status and coverage verification
• Provide customer service
• Participate in interactions with TPA adjusters and claims partners
• Improve claims operations

Requirements

• High School Diploma or equivalent is required
• Minimum of 2-years workers’ compensation claims experience is required
• Experience in specific states is preferred
• Strong communication skills
• Strong problem-solving skills
• Awareness of tasks and impact
• Experience using G-Suite and collaboration tools is preferred
• Knowledge of jurisdictional regulatory and statutory requirements
• Demonstrated knowledge in claim adjudication, medical management and litigation management
• Ability to analyze and take necessary action
• Ability to overcome conflict
• Ability to make claim decisions

Benefits

• No benefits