Workers' Compensation Claims Adjuster I

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

📋 Description

• Evaluate claim notifications, policies, contracts, and relevant state regulations to establish coverage, jurisdiction, deductibles, and compensability.

• Perform prompt investigations of claims by reaching out to insured individuals, injured workers, witnesses, and other pertinent parties; gathering statements; and obtaining reports and documentation.

• Record claim activities, keep precise file diaries, set appropriate reserves, and ensure timely management of claims until resolution.

• Analyze medical records, treatment plans, invoices, and other relevant documents to comprehend injuries, assess costs, and coordinate suitable medical care.

• Calculate and manage wage benefits while monitoring any changes that may influence benefit amounts.

• Facilitate return-to-work initiatives with injured workers, insured parties, medical providers, and other relevant stakeholders.

• Identify and pursue opportunities for recovery and subrogation and refer claims to specialized resources as needed.

• Investigate and address issues related to compensability and coverage, and communicate decisions and claim statuses effectively.

• Prepare evaluations for settlements, negotiation tactics, IME documentation, and correspondence for denials.

• Collaborate with attorneys and engage in mediations, settlement discussions, and other activities related to claim resolution.

• Advocate for claims programs and resources, including OCN, RTW, and SPP initiatives.

• Work in partnership with Claims, Underwriting, Risk Improvement, and other internal teams; create risk alerts and support wider claims initiatives.

⛳️ Requirements

• Bachelor’s degree or equivalent relevant experience is required.

• At least one year of experience in workers’ compensation claims adjusting or a related field.

• Experience in Oklahoma, Kansas, Arkansas, and Kentucky is preferred.

• Must obtain all applicable state licenses within one year of employment.

• Relevant insurance designations are preferred.

• Understanding of the theory and practice associated with claims functions is necessary.

• Familiarity with insurance contracts, medical terminology, and substantive and procedural laws is essential.

• Ability to maintain high standards of professional conduct and uphold the code of ethics.

• Proficient in computer systems and claims management software.

• Excellent organizational, written, and verbal communication skills.

• Good investigative skills and problem-solving capabilities are required.

• Occasional travel may be necessary.

• A valid driver’s license with an acceptable motor vehicle report according to company standards is required for driving.

🏝️ Benefits

• Comprehensive rewards package.

• Opportunity to work remotely from anywhere in the United States.

• Tobacco-free workplaces and company vehicles.