Claims Adjuster – Workers Comp

This is a fully remote position, open to applicants in Washington.

📋 Description

• Analyze mid- and higher-level workers compensation claims to ascertain the benefits owed;

• Ensure the continuous adjudication of claims aligns with company standards and industry best practices;

• Identify claim subrogation and negotiate settlements.

• Oversee workers compensation claims by determining compensability and benefits for long-term indemnity claims, monitoring reserve accuracy, and submitting required documentation to state agencies.

• Create and manage action plans for workers compensation claims until resolution, coordinate return-to-work initiatives, and authorize claim payments.

• Approve and process assigned claims, ascertain benefits owed, and manage action plans in accordance with the claim or client contract.

• Handle subrogation of claims and negotiate settlements effectively.

• Communicate claim actions with both claimants and clients.

• Ensure claim files are thoroughly documented and claims coding is accurate.

• May handle complex lifetime medical and/or defined period medical claims, which involve state and physician filings and decisions regarding recommended treatments from utilization reviews.

• Maintain professional relationships with clients.

⛳️ Requirements

• Preferred: Bachelor's degree from an accredited college or university.

• Required: Four (4) years of claims management experience or a suitable combination of education and experience.

• Knowledgeable in regulations, offsets and deductions, disability duration, medical management practices, and the application procedures for Social Security and Medicare as they pertain to the line of business.

• Strong oral and written communication skills, including proficiency in presentations.

• Proficient in PC usage, including Microsoft Office applications.

• Possess analytical and interpretive abilities.

• Strong organizational capabilities.

• Good interpersonal skills.

• Excellent negotiation abilities.

• Capable of working collaboratively in a team environment.

• Ability to meet or surpass Service Expectations.

🏝️ Benefits

• Choose from three medical and two dental plans.

• Eligibility for tuition reimbursement.

• 401K plan that matches 50% of every dollar you contribute up to the first 6% you save.

• Enjoy 4 weeks of PTO in your first full year.