Workers' Compensation Claims Adjuster

Worker's Compensation Claims Adjuster

The Worker's Compensation Claims Adjuster will manage a caseload of approximately 150 open claims, exercising good judgment while resolving claims according to our established procedures and best claims practices, in accordance with statutory, regulatory, and ethical requirements.

Essential Functions :

• Receive and review initial workers' compensation claims, verifying the accuracy and completeness of claim forms and supporting documentation
• Conduct thorough investigations to determine validity and extent of injury; interview the injured employee, employer(s), and any witnesses, as well as review medical reports, and accident reports to determine causality, and compensability
• Effectively communicate with the injured worker, employer(s), medical professionals, and legal representatives, as needed, providing ongoing updates and information to all parties involved in the claim process
• Make appropriate determinations on the approval, or denial, of claims, based on investigation findings and applicable laws; calculate correct benefit amounts, including medical expenses, wage replacement, and any other necessary compensation
• Manage and monitor open claims to ensure timely and appropriate processing; coordinate return-to-work programs and rehabilitation services
• Effectively maintain detailed and accurate records for each claim; prepare and submit required documentation and reports to regulatory bodies and insurance companies
• Timely initiate, maintain, and terminate temporary, impairment, and supplemental income benefits
• Identify and pursue subrogation, when there is 3rd party negligence, and negotiate fair settlement for all parties involved
• Address and resolve any disputes or issues that arise during the claim process
• Review all activities relating to the public, customers, and companies to avoid issues involving potential errors and omissions and ensure compliance with workers' compensation laws and regulations
• Participate in seminars and other training to maintain required licenses and for knowledge and skill development

Additional Responsibilities :

This job description is intended to describe the level of work required of the person performing the position. Essential functions are outlined; however, other duties may be assigned, as needs arise, or as necessary to support the essential functions. Specific performance objectives may be developed each year to measure the performance of the tasks and functions listed in this job description.

Telecommuting opportunities vary by location, department, and business need and are subject to change, as needed. Each manager will provide details on any telecommuting opportunities, as well as scheduling, within their department.

Knowledge, Skills, and Abilities :

Qualifications :

Working Conditions and Reasonable Accommodations :