Occupational Accident Claims Adjuster – Work Comp Paralegal/Legal Assistant

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

📋 Description

• Investigate and adjust assigned occupational accident claims in accordance with established procedures, guidelines, supervisory protocols, policy language, and authority levels.

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

• Authorize and process claim payments that are medically necessary and related.

• Make timely and well-supported decisions regarding claims.

• Forecast potential exposure for claims reserves.

• Maintain ongoing communication with policyholders.

• Negotiate settlements when deemed appropriate.

• Provide high-quality claim service and respond effectively to client needs.

• Review jurisdictional challenges and assess potential exposure.

• Efficiently manage time and caseloads.

• Utilize established forms and adjust letters in accordance with policy provisions.

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

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

• Review policies and administer benefits as per policy terms.

• Steer claims towards optimal resolution.

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

• Perform additional duties as assigned.

⛳️ Requirements

• High school diploma or equivalent qualification.

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

• Proficiency in Microsoft Office applications.

• Successful completion of the pre-employment assessment.

• Strong attention to detail and excellent organizational skills.

• Ability to work independently with minimal supervision.

• Strong verbal and written communication skills.

• Capacity to use discretion and maintain confidentiality.

• Ability to function effectively as a team player.

• Flexibility and initiative are essential.

🏝️ 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 holiday leave.

• Opportunities for professional development.

• A supportive and collaborative work environment.

• Manageable caseloads to ensure work-life balance.

• Access to the necessary resources to perform job duties effectively.