Senior Workers’ Compensation Adjuster

About the role

This position is responsible for a variety of professional duties in handling workers’ compensation claims in Georgia for Georgia Power, along with handling claims in Georgia for Southern Company Services, Southern Power, and Southern Communications, and providing backup workers’ compensation claim support for Southern Nuclear Company in both Georgia and Alabama.

Responsibilities

• Partners with employees, leadership, Medical & Health Services, Safety, medical providers, vendors, and legal counsel to effectively manage and resolve claims
• Determines compensability and manages claims in accordance with Alabama and Georgia Workers’ Compensation laws, rules, and company policies
• Collaborates with external defense counsel to investigate claims and evaluate compensability based on case-specific facts and circumstances
• Serves as a cross-trained resource supporting Southern Nuclear Workers’ Compensation claims across Georgia and Alabama jurisdictions to ensure continuity and consistency
• Applies professional judgment to manage a broad range of complex claim types, including medical-only, lost-time, catastrophic, death, controverted, and litigated claims
• Calculates, analyzes, and manages claim financials, including historical spend and future reserve estimates
• Ensures timely and accurate processing of payments, including indemnity, medical, legal, and related expenses
• Identifies and proactively pursues claim resolution opportunities, including return-to-work strategies, settlements, and appropriate benefit discontinuation
• Evaluates claims for cost containment opportunities while ensuring appropriate and quality medical care
• Coordinates reimbursement and recovery efforts, including excess insurance, Subsequent Injury Trust Fund, and subrogation opportunities
• Communicates with Payroll to ensure proper handling of indemnity offsets and salary-in-lieu payments
• Maintains accurate and detailed claim documentation, including notes, action plans, and supporting information within claim systems
• Ensures compliance with all state and federal reporting requirements, including Georgia State Board filings and Medicare Section 111 reporting and CMS requests
• Supports required annual filings, including reporting for the State Board of Workers’ Compensation and the Self-Insured Guaranty Trust Fund
• Coordinates Medicare Set-Aside (MSA) reporting and funding and facilitates arrangements and communications
• Manages vendor setup processes, including requesting W-9s and obtaining billing information for payment processing
• Oversees medical management activities, including bill review approvals, pharmacy benefit management requests, and processing of employee reimbursements (e.g., mileage, out-of-pocket expenses)
• Utilizes automation tools, including Power Automate, to support and streamline workflows where appropriate
• Buils and maintains strong working relationships with external vendors, ensuring timely communication, responsiveness, and issue resolution
• Utilizes professional judgment to manage a broad range of complex claim types, including medical-only, lost-time, catastrophic, death, controverted, and litigated claims
• Serves as Company Representative for claims, including providing testimony at hearings, depositions, mediations, and other legal proceedings
• Presents settlement evaluations to management to obtain appropriate settlement authority and leads negotiations to resolve claims
• Evaluates claims for closure opportunities and develops resolution strategies
• Negotiates settlements with pro se claimants and supports counsel with requests in order to finalize settlement documentation and agreements
• Coordinates subrogation efforts with motor vehicle insurers and legal representatives when third-party liability exists
• Communicates directly with opposing counsel, when appropriate, to support timely resolution and cost management of legal expenses
• Provides training and support to other claims professionals as needed
• Assists with special projects as assigned

Requirements

• Minimum 5 years claims related experience in handling complex workers’ compensation claims required
• Ideal candidate will have claims experience in Georgia and Alabama
• Knowledge of accepted industry standards and practices

Qualifications

• Education: High School Diploma Required
• Associate Degree or Bachelor's Degree Desired

Skills

• Strong compliance component to follow federal laws and guidance, state laws and rules, and company processes and policies in handling claims
• Proficient in using claim systems and business applications, including Assure Claims, ICMS II, Oracle, Mobi, Medicare Section 111 reporting tools, third-party medical and pharmacy platforms, and Microsoft 365 applications (Outlook, Excel, Word, Forms, SharePoint, OneNote, Power Automate)
• Excellent communication skills and works effectively in a collaborative team environment
• Ability to quickly learn and effectively utilize claim systems and business applications, with the expectation of ongoing learning as systems and processes evolve
• Adapts quickly to evolving processes, systems, and workflows

Benefits

Please Note: This is a hybrid position with in-office presence expectation at 241 Ralph McGill Blvd, Atlanta, GA. For more information, visit https://seo.nlx.org/southernco/pdf/SOCO-Benefits.pdf.