Senior Workers' Claims Adjuster

Responsibilities

• Investigate and evaluate claims to determine coverage, compensability, and liability
• Conduct thorough investigations, including interviews with claimants, employers, and witnesses
• Obtain and review relevant documentation (e.g., medical records, police reports, employment records)
• Develop and implement strategic action plans for claim resolution
• Prepare and present clear, accurate, and timely reports to clients and carriers
• Manage EDI reporting and CMS/Section 111 compliance requirements
• Negotiate settlements with claimants and legal representatives to achieve fair resolutions
• Oversee litigation activities, ensuring effective cost control and alignment with account requirements
• Utilize approved vendor partners to support claims handling activities
• Handle complex claims, including catastrophic losses and sensitive issues
• Respond promptly and professionally to client inquiries and communications
• Maintain compliance with all licensing and regulatory requirements
• Stay current with industry trends, legal updates, and best practices through ongoing training
• Support team development by mentoring and sharing expertise with colleagues, as needed
• Perform other duties as assigned

• Active New Mexico Adjuster License (required)
• 5–7 years of experience handling workers’ compensation claims, including complex files
• Bachelor’s degree or equivalent combination of education and professional experience
• Proven experience handling litigation and complex claim scenarios preferred
• Strong understanding of workers’ compensation claims handling principles and practices
• Knowledge of medical terminology and legal concepts, including litigation management
• Ability to conduct detailed investigations in multi-party environments
• Excellent analytical and problem‑solving skills with strong attention to detail
• Ability to manage multiple priorities and meet time‑sensitive deadlines
• Proficiency with claims management systems and standard business software
• Strong written and verbal communication skills, including report writing and presentations
• Ability to maintain confidentiality and exercise sound judgment
• Ability to quickly learn and adapt to evolving processes, regulations, and technology
• Working knowledge of multi‑state laws and regulations is a plus
• Ability to work both independently and collaboratively in a hybrid work environment

• New Mexico Adjuster License