Senior Claims Adjuster, Workers Compensation

This is a remote U.S.-based role for a partner company that manages all applications and next steps. The position focuses on managing complex workers’ compensation claims while delivering a high-quality, customer-focused experience.

About the role

You will independently oversee workers’ compensation claims from initial setup through resolution, balancing technical accuracy, regulatory compliance, and exposure management. The role centers on high-dollar and high-exposure cases requiring strong investigation, judgment, negotiation, and mitigation skills. You’ll collaborate with internal teams, agents, insureds, medical professionals, defense counsel, and external partners to achieve favorable outcomes.

Responsibilities

• Independently manage workers’ compensation claims throughout the entire lifecycle, from initial setup and investigation through closure.
• Handle complex, high-dollar, and high-exposure claims, continuously evaluating changing facts and identifying opportunities to mitigate financial and operational exposure.
• Conduct timely three-point contact investigations and make accurate compensability decisions in accordance with applicable statutory requirements.
• Establish and adjust reserves promptly and accurately, ensuring reserves reflect current claim facts, exposure, and established best practices.
• Administer statutory medical and indemnity benefits throughout the life of each claim while maintaining compliance with applicable laws, regulations, and jurisdictional requirements.
• Manage litigation activity in partnership with defense counsel, including oversight of legal strategy, fees, costs, and opportunities for early resolution.
• Evaluate settlement opportunities, negotiate resolutions, and make sound claim decisions designed to achieve favorable outcomes.
• Present complex claims, exposure assessments, and recommendations to senior management and internal or external stakeholders.
• Serve as a trusted point of contact for agents, insureds, and business partners, providing claim guidance, status updates, coverage information, and loss-run support as needed.
• Deliver a high-quality customer experience by setting clear expectations, communicating effectively, and advocating for timely and effective claims resolution.
• Identify gaps and improvement opportunities across claims operations, service standards, handling procedures, protocols, and workflows.
• Mentor junior adjusters and contribute to a culture of accountability, collaboration, continuous improvement, and technical excellence.

Requirements

• High school diploma or equivalent required; a bachelor’s degree or equivalent experience with some college coursework is preferred.
• At least 5 years of workers’ compensation claims adjusting experience required, preferably within a carrier environment.
• Experience handling workers’ compensation claims in states such as Florida, Georgia, North Carolina, South Carolina, and/or Tennessee is preferred.
• Active claims licensing in applicable states is required.
• Demonstrated ability to evaluate and manage high-dollar, high-exposure, and complex workers’ compensation claims.
• Advanced knowledge of jurisdictional regulatory and statutory requirements, as well as CMS/MSA requirements.
• Strong experience in claim adjudication, medical management, litigation management, reserving, compensability analysis, and settlement negotiations.
• Ability to analyze multiple sources of information, identify key risks, and take appropriate action across complex claims.
• Strong judgment and problem-solving skills, with the ability to independently navigate difficult situations and determine effective solutions.
• Excellent written and verbal communication skills, including the ability to explain complex claims information clearly to different audiences.
• Demonstrated ability to manage conflict, negotiate effectively, and pursue outcomes that balance customer needs with business objectives.
• Strong organizational skills and awareness of how individual responsibilities affect broader team performance and deliverables.
• Ability and willingness to mentor and support the development of junior claims professionals.
• Familiarity with G-Suite and collaboration platforms such as Slack is preferred.

Benefits

• Salary: $85,000–$110,000 USD base compensation range.
• Competitive cash compensation with potential for discretionary bonuses based on company performance and eligibility.
• Comprehensive health insurance plans.
• Generous paid time off.
• 401(k) retirement plan with employer matching.
• Generous parental and caregiver leave.
• Remote work opportunity for team members living and working in the United States, excluding U.S. territories.
• Flexible, technology-enabled work environment supported by reliable high-speed internet.
• Collaborative culture focused on customer impact, continuous improvement, accountability, and innovation.
• Opportunities to contribute to process improvements and develop professionally within a growing insurance technology environment.