Senior Claims Adjuster, Workers Compensation

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

📋 Description

• Manage all facets of workers’ compensation claims independently, from initiation to resolution.

• Assess and manage high-value, high-risk, and intricate claims.

• Perform prompt three-point contact investigations and continue to investigate as case details evolve.

• Mitigate complex exposures while pursuing optimal outcomes.

• Make timely and precise compensability decisions within statutory guidelines.

• Establish and adjust accurate reserves promptly within authority limits.

• Present claims to senior management as well as internal and external stakeholders.

• Oversee statutory medical and indemnity benefits throughout the claim lifecycle.

• Adhere to relevant statutory guidelines, rules, and regulations.

• Manage legal activities with defense counsel while controlling legal fees and expenses.

• Focus on early resolution opportunities, assess claim exposure, and negotiate settlements.

• Act as a liaison for partner agents and clients, offering claim guidance and establishing process expectations.

• Deliver claim status updates, coverage verification, and loss run reports to agents and insured parties.

• Provide exceptional service to both internal and external customers and business partners.

• Continuously enhance claims operations, service quality, SOPs, protocols, and processes.

⛳️ Requirements

• A High School Diploma or equivalent is necessary.

• A Bachelor's Degree or equivalent experience with some college coursework is preferred.

• A minimum of 5 years of experience in workers’ compensation claim adjusting is required (carrier experience is preferred).

• Claims experience in FL, GA, NC, SC, and TN is preferred.

• Active licensing in applicable states is required.

• Excellent communication skills, both written and verbal.

• Strong problem-solving abilities.

• Experience with G-Suite Tools and collaboration tools like Slack is preferred.

• Advanced knowledge of jurisdictional regulatory and statutory requirements, along with CMS/MSA requirements.

• In-depth knowledge and experience in claim adjudication, medical, and litigation management.

• Advanced capability to analyze and respond to multiple focus areas based on various data points.

• Ability to make claim decisions that mitigate exposure while achieving favorable outcomes.

• Proficient in conflict resolution and reaching beneficial outcomes.

• Capability to mentor junior adjusters.

🏝️ Benefits

• Competitive cash compensation

• Comprehensive health plans

• Generous PTO

• Future-focused 401k match

• Generous parental and caregiver leave

• Discretionary bonuses may be awarded annually to eligible team members