Workers Compensation Claims Adjuster

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

📋 Description

• Oversee a caseload of moderately intricate casualty claims from the point of intake through to resolution.

• Perform comprehensive investigations, evaluate liability, and assess damages following established protocols.

• Collaborate with underwriting, legal teams, and both internal and external stakeholders as necessary to ensure thorough claim evaluations.

• Identify and escalate potentially suspicious claims to the Special Investigations Unit.

• Apply comparative negligence laws and state-specific regulations during claim assessments.

• Set reserves, authorize payments, and exhibit financial expertise within the bounds of authority.

• Leverage technology and data tools to improve claims processing efficiency and precision.

• Engage directly with claimants, legal representatives, and third parties to negotiate equitable resolutions.

• Keep meticulous and compliant records of claim activities and communications.

• Participate in team collaboration, problem-solving sessions, and cross-functional coordination.

• Assist in subrogation initiatives and risk transfer opportunities that benefit insureds and business partners.

• Manage sensitive communications professionally and simplify complex information for varied audiences.

• Guide entry-level claim handlers and share best practices acquired through training and experience.

• Attend ongoing training and educational sessions to maintain licensing and stay informed on industry standards.

• Independently handle indemnity, medical, and fundamental arbitration or mediation aspects of claims with supervisory support.

• Must possess or obtain and maintain the appropriate state adjuster licenses.

⛳️ Requirements

• Associate degree is required; a bachelor's degree is preferred or a combination of education and experience is acceptable.

• Typically requires 1-4 years of pertinent claims handling experience.

• Conduct independent analysis regarding contractual indemnification.

• Ability to independently manage indemnity, medical, and litigation/resolution processes.

• Proficient in basic computer navigation; capable of utilizing fundamental software systems/applications (Suite of MS Office Products) and internet usage.

• Learn and manage negotiations independently within authority, and understand common strategies for moderately complex claim resolutions.

• Familiarity with various types of insurance products and their processes.

• Conduct thorough investigations; identify key issues and collect evidence.

• Provide effective and empathetic customer service; manage routine inquiries and issues.

• Capable of using a personal computer and other standard office equipment.

• Proficient in all Microsoft Office products.

• Ability to sit and/or stand for extended durations.

• Required to work on-site as needed.

• Willingness to travel as necessary.

• Capability to work in a fast-paced, dynamic, or stressful environment.

• Ability to perform tasks in a noisy/loud work environment.

• May be required to have and maintain a sufficient home-based internet connection.

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with company match.

• Paid time off and flexible working hours.

• Opportunities for professional development and career advancement.