Workers Compensation Claims Adjuster II

Job Description

Workers Compensation Claims Adjuster

Job Summary

Seeking an experienced and detail-oriented Workers Compensation Claims Adjuster to manage indemnity claims from initial report through resolution. This role requires a strong understanding of workers compensation laws and regulations, the ability to evaluate complex claims, and a commitment to timely compliant and customer-focused claim handling. Responsibilities include investigation documentation collaboration with vendors and medical partners and proactive claim resolution.

Responsibilities

• Conduct three-point contact on all new losses within required time frames including outreach to the claimant employer and treating physician
• Investigate claims thoroughly to establish compensability disability status and treatment plans
• Maintain accurate and timely documentation of all claim activity medical updates and expense payments
• Develop and maintain an up-to-date action plan for each assigned indemnity claim to drive timely resolution
• Partner with medical case management to support early return-to-work initiatives and minimize extended disability exposure
• Coordinate the use of vendors as needed to support claim investigation and resolution
• Identify and refer suspected fraudulent claims to the appropriate special investigations unit
• Ensure compliance with applicable workers compensation laws regulations and internal guidelines

Compensation Package

• Base salary range: $80000 $ 98000 annually (depending on experience)
• Competitive benefits package: paid time off, professional development opportunities, etc.

Qualifications / Requirements

• 3 5 years of workers compensation claims handling experience
• Demonstrated experience managing indemnity claims
• Familiarity with applicable workers compensation regulations and procedures
• Experience with 4850 claims handling or SIP exposure
• Strong organizational, analytical and communication skills

Disclaimer:
Please note that this job description may not cover all duties, responsibilities or aspects of the role and it is subject to modification at the employer's discretion.

#LI-JJ1

• Load & Unload
• Organizational skills
• Financial Concepts
• Fraud
• Math
• Mediation Experience
• Pricing
• Conflict Management
• Workers' Compensation Law
• Medicare
• Negotiation
• Workers' Compensation

Employment Type: Full-Time

Experience: years

Vacancy: 1

Yearly Salary Salary: 80000 - 98000