Medical Only Claims Adjuster

About the role

Seeking a dedicated and detail-oriented Lost Time Workers' Compensation Claims Adjuster to join a growing team. This is a remote position, ideal for candidates located in the EST or CST time zones who are willing to work EST hours (7:00 AM - 9:00 AM EST start). As a key member of our claims team, you will manage a caseload of 90-120 files, with 5-10% involving litigation, across a variety of industries including transportation, schools, hospitality, and manufacturing. This role requires a strategic mindset, investigative expertise, and a commitment to delivering exceptional service.

Compensation

Salary: $70,000 - $80,000 annually
Quarterly Bonuses: Performance-based, up to $500 per quarter

Responsibilities

• Conduct thorough investigations of new claims, including contacting employers and injured workers for recorded statements.
• Determine coverage and assess the validity of claims.
• Review medical bills to ensure proper payment and refer bills for audit when necessary.
• File required forms with the Industrial Commission.
• Establish appropriate reserves for claims.
• Coordinate medical case management services and ensure injured employees receive necessary care.
• Communicate effectively with insureds, injured workers, and attorneys.
• Attend mediations and hearings as required.
• Utilize proprietary claims software and ImageRight to manage claims efficiently.

Qualifications

• Minimum of 2 years of experience handling Workers' Compensation claims.
• Proven ability to independently solve practical problems and prioritize tasks effectively.
• Strong interpersonal skills with the ability to build and maintain professional relationships.
• Experience adjusting claims in at least two of the following states: NC, SC, GA, TN (NC experience is highly preferred).
• Adjuster’s license in one or more states is a plus.
• Fluent in English; Spanish language skills are a plus.
• Demonstrated ability to employ strategic thinking and investigative techniques to manage claims.