Claims Adjuster - Workers Compensation - Remote​/Telecommute

Job Description: The Claims Adjuster – Workers Compensation is responsible for managing workers’ compensation claims from initial investigation through resolution. This role ensures accurate determination of compensability, benefits, reserves, and compliance with applicable state regulations while maintaining strong communication with all stakeholders.

• Manage workers’ compensation claims, including determining compensability and benefits on long-term indemnity claims.
• Monitor reserve accuracy and file required documentation with state agencies.
• Develop and manage claim action plans through resolution.
• Coordinate return-to-work efforts and approve claim payments.
• Approve and process assigned claims in accordance with claim or client contracts.
• Manage subrogation and negotiate claim settlements.
• Communicate claim actions with claimants and clients.
• Ensure claim files are accurately documented and properly coded.
• Process complex medical claims, including state and physician filings and treatment determinations based on utilization review.
• Maintain professional relationships with clients and stakeholders.
• Support organizational quality programs and perform other assigned duties.

• End-to-end management of lost time and indemnity workers’ compensation claims.
• Experience reserving claims for ultimate exposure.
• Ability to manage active caseloads, diaries, and correspondence.
• In-depth knowledge of Pennsylvania and New Jersey workers’ compensation statutes, regulations, and case law.
• Experience with state-specific workers’ compensation forms and EDI filings.
• Strong understanding of wage loss and benefit calculations, including average weekly wage and disability benefits.
• Experience coordinating medical treatment, utilization review, and compliance with state fee schedules.
• Experience handling litigated claims, working with defense counsel, and participating in hearings.
• Strong return-to-work coordination experience with employers.
• Excellent documentation, customer service, and communication skills.
• Experience negotiating settlements, including lump-sum agreements and compromise resolutions.

• Strong jurisdictional knowledge of workers’ compensation regulations.
• Effective negotiation and settlement skills.
• Excellent written and verbal communication.
• Strong organizational and documentation skills.
• Ability to manage complex claims and multiple priorities effectively.