Workers Compensation Adjuster

This is a fully remote position, open to applicants in California, +5 more states.

📋 Description

• Receive newly filed claims.

• Assess coverage in accordance with the State Workers’ Compensation Act and exposure to LHWCA.

• Maintain and update claim notes throughout the entire claim lifecycle.

• Enter claim information into an electronic database.

• Conduct interviews with claimants, insured parties, medical professionals, and witnesses to ascertain claim validity.

• Communicate decisions regarding claim compensability to claimants, employers, and medical providers.

• Set appropriate reserves based on the nature and severity of injuries.

• Calculate lost-time wages and process disability payments for claimants.

• Report mandatory claims data to state entities within specified timeframes.

• Order independent medical examinations and prepare necessary documentation for physician review.

• Maintain ongoing correspondence with claimants, insured parties, clients, and nurse case managers.

• Review and process medical bills to identify additional discount opportunities.

• Collaborate with claimants, clients, and insured parties to facilitate early return-to-work outcomes.

• Partner with legal counsel on litigated claims and provide necessary documentation for defense.

• Attend settlement conferences, mediations, and hearings on behalf of the insurance company.

• Review and approve defense attorney bills within authorized limits.

• Collaborate with underwriting on loss information for renewal rates and with Risk Management to identify trends.

• Respond to state requests regarding health cost disputes, hearing applications, and penalty assessment letters.

• Identify subrogation opportunities and pursue recovery efforts.

• Lead claim reviews with clients as requested.

⛳️ Requirements

• Over 5 years of experience managing Workers Compensation claims in CT, DE, MD, CA, NJ, PA, RI.

• Valid Multi-state Adjuster license.

• Preferred experience and current adjuster's license for handling WC claims in CT, DE, MD, CA, NJ, PA, RI.

• High School diploma or equivalent education.

• Proficient in the complete Microsoft Office suite.

• Knowledgeable in relevant workers’ compensation laws.

• Strong understanding of medical terminology.

• Familiar with medical cases and typical treatment progression.

• Exceptional professional oral and written communication skills.

• Keen attention to detail and strong organizational skills.

• Capable of negotiating issues and settlements effectively.

• Strong commitment to customer service, ensuring timely responses to requests and inquiries.

• Ability to adapt to evolving technologies and learn new systems and equipment.

• Capacity to establish and maintain effective working relationships with others.

🏝️ Benefits

• Comprehensive medical, dental, and vision benefits.

• Company contributions to Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).

• Employer-paid life and disability insurance coverage.

• 401(k) plan with company matching contributions.

• Paid time off (PTO) in addition to company-paid holidays.

• Employee assistance resources available.

• Supportive workplace culture that prioritizes balance and well-being.

• Complete benefits package offered.