Senior Claims Adjuster

Key Responsibilities

• Ownership of Workers’ Compensation claims from intake through resolution.
• Accountability for claim strategy, reserving, and overall claim outcomes.
• Acting as a subject matter expert in Maryland Workers’ Compensation regulations and best practices.
• Partnering with clients, carriers, and internal teams to align claim handling with business objectives.
• Investigate, evaluate, and manage indemnity Workers’ Compensation claims.
• Determine compensability through claim analysis and recorded statements.
• Cookordinate and monitor medical treatment and return-to-work strategies.
• Calculate and issue indemnity payments and review medical billing for accuracy.
• Maintain accurate and timely claim documentation within claim systems (e.g., Spear).
• Ensure compliance with jurisdictional requirements and filing deadlines.
• Provide regular claim status updates and reporting to stakeholders.
• Monitor claims for risks, trends, and opportunities for resolution improvement.
• Serve as liaison between employees, employers, medical providers, and legal partners.
• Collaborate with defense counsel on litigated claims and attend hearings as needed.
• Coordinate vendors such as nurse case managers and vocational specialists.
• Ensure smooth communication and alignment across all claim stakeholders.
• Participate in client claim review meetings and strategic planning discussions.
• Support process improvements and organizational initiatives related to claims management.
• Assist in developing scalable practices for consistent claim handling excellence.
• Identify opportunities to improve claim processes and workflows.
• Apply industry best practices and regulatory standards (e.g., AMA guidelines).
• Promote efficiency, accuracy, and continuous improvement in claims handling.

Required Qualifications

• A high school diploma or GED.
• Some college preferred.
• 5+ years of Workers’ Compensation or related claims experience.
• Strong communication and interpersonal skills.
• Ability to manage multiple claims and meet deadlines.
• Analytical and decision-making capabilities.
• Proficiency in Microsoft Office and claim management systems.

Preferred Experience

• Handling Maryland Workers’ Compensation claims.
• Experience with litigated claims and legal collaboration.
• Familiarity with claim systems such as Spear.