Claims Adjuster, Worker's Compensation

Accountabilities

• Independently manage workers’ compensation claims from initial setup through closure, ensuring timely and accurate handling throughout the claim lifecycle.
• Conduct thorough claim investigations, including timely three-point contact and ongoing evaluation as case circumstances evolve.
• Analyze claim exposure, determine compensability decisions, and make informed recommendations based on available facts and regulatory requirements.
• Establish and adjust reserves within assigned authority levels while ensuring accuracy and alignment with claim best practices.
• Manage medical and indemnity benefits administration in compliance with applicable state regulations and requirements.
• Monitor and control legal activity, collaborating with defense counsel to manage litigation processes, costs, and outcomes.
• Identify opportunities for early resolution, negotiate settlements, and pursue strategies that reduce claim exposure while achieving favorable results.
• Serve as a trusted point of contact for customers, agents, and business partners by providing claim guidance, updates, and support.
• Deliver excellent customer service while setting clear expectations throughout the claims process.
• Collaborate with third-party administrators, claims partners, and internal teams to improve claim outcomes and customer experiences.
• Identify operational improvements and contribute to enhancements in claims processes, procedures, and service standards.
• Maintain compliance with applicable statutory guidelines, regulatory requirements, and industry best practices.
• Support continuous improvement initiatives focused on claims quality, efficiency, and customer satisfaction.

Requirements

• The ideal candidate is an experienced workers’ compensation claims professional with strong knowledge of claim adjudication, investigation, and regulatory requirements.
• You should be comfortable managing complex claims independently while providing excellent service to customers and partners.
• Minimum of 2 years of workers’ compensation claims handling experience required.
• Experience managing workers’ compensation claims in states such as Florida, Georgia, North Carolina, South Carolina, and Tennessee preferred.
• Strong understanding of claims adjudication, medical management, litigation management, and settlement strategies.
• Knowledge of jurisdictional regulatory requirements and CMS/MSA guidelines.
• Ability to analyze complex claim information and make sound decisions to mitigate exposure while achieving positive outcomes.
• Strong problem-solving skills with the ability to manage priorities independently and work through complex situations.
• Excellent written and verbal communication skills, including the ability to explain complex information clearly.
• Strong customer service mindset with the ability to build effective relationships with internal and external stakeholders.
• Able to collaborate effectively with claims partners, agents, customers, and cross-functional teams.
• Experience using collaboration tools such as G-Suite and Slack is preferred.
• Strong organizational skills and ability to manage multiple priorities in a remote work environment.

Benefits

• Competitive annual salary range of approximately $70,000-$90,000 USD.
• Fully remote work opportunity within the United States.
• Competitive cash compensation package.
• Comprehensive health insurance plans.
• Generous paid time off.
• Future-focused 401(k) retirement plan with company match.
• Generous parental and caregiver leave benefits.
• Opportunity to contribute to a technology-driven insurance organization focused on improving the small business experience.
• Collaborative culture built around innovation, ownership, and continuous improvement.