We are seeking a knowledgeable and detail-oriented Workers' Compensation Adjuster to manage and investigate workers' compensation claims from initiation through resolution. This role involves evaluating claims, determining compensability, coordinating with medical providers, and ensuring compliance with state regulations while delivering excellent service to claimants and employers.
Key Responsibilities:
- Investigate, evaluate, and manage workers' compensation claims in accordance with applicable laws and company policies
- Determine claim validity, compensability, and appropriate benefits (medical, wage replacement, etc.)
- Communicate with injured employees, employers, medical providers, attorneys, and other stakeholders
- Monitor medical treatment and facilitate return-to-work programs where applicable
- Maintain detailed claim notes and documentation in the claims management system
- Calculate and authorize payment of medical bills, temporary disability, permanent disability, and other related expenses
- Negotiate claim settlements and ensure timely resolution
- Ensure compliance with state-specific workers’ compensation regulations and deadlines
- Prepare and submit required forms, reports, and correspondence to regulatory agencies
- Collaborate with internal legal, risk management, and HR teams as needed
Qualifications:
- High school diploma or GED required; Associate’s or Bachelor’s degree preferred
- 2+ years of experience handling workers’ compensation claims
- State adjuster license (if required)
- Strong knowledge of workers' compensation laws and procedures in applicable jurisdictions
- Excellent communication, negotiation, and interpersonal skills
- Proficient in claims management systems and Microsoft Office Suite
- Strong organizational and time management abilities
- Ability to handle sensitive and confidential information with discretion
Work Environment:
- Full-time; remote, hybrid, or in-office depending on company policy
- Fast-paced environment with a high volume of case management
- May require occasional travel for hearings or investigations