Occupational Accident Claims Adjuster / Work Comp Paralegal / Work Comp Adjuster

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

📋 Description

• Conduct investigations and make adjustments to assigned occupational accident claims in accordance with established protocols, guidelines, policy language, and supervision.

• Assess medical, legal, and miscellaneous invoices for appropriateness and relevance to occupational accident claims.

• Authorize and process claims payments within defined protocols and authority limits.

• Handle medically necessary and relevant bills in line with policy provisions.

• Make timely and well-supported claim decisions.

• Anticipate potential exposures for claim reserving purposes.

• Maintain ongoing communication with policyholders.

• Negotiate settlements as appropriate and within authority limits.

• Provide high-quality claims service and address client needs effectively.

• Assess jurisdictional challenges and potential exposures.

• Oversee caseloads, manage time, and handle forms, letters, and claim documentation.

• Review and document medical records, treatment plans, restrictions, and action plans.

• Identify mechanisms of injury, symptoms, and unrelated conditions.

• Review policies and administer benefits in accordance with policy terms.

• Manage claims towards optimal resolution.

• Cultivate relationships with insured parties, motor carriers, brokers, providers, and preferred vendors.

• Perform additional duties as assigned.

⛳️ Requirements

• High school diploma or equivalent qualification.

• Minimum of two years of experience in medical claims, claims adjusting, paralegal work, or as a legal assistant.

• Proficient in Microsoft Office applications.

• Successful completion of the pre-employment assessment.

• Strong attention to detail and excellent organizational skills.

• Ability to work with minimal direct supervision.

• Capacity to maintain discretion and confidentiality.

• Excellent verbal and written communication skills.

🏝️ Benefits

• Competitive salary with potential performance-based bonuses.

• Medical, dental, and vision insurance coverage.

• 401(k) plan with company matching contributions.

• Paid time off and designated holidays.

• Opportunities for professional development.

• A supportive and collaborative work environment.

• Manageable caseloads.

• Access to necessary resources to perform the job effectively.