Workers' Compensation Claim Adjuster

Job Summary

We are seeking an experienced and highly skilled Workers’ Compensation Claim Consultant to manage a complex portfolio of claims with confidence, empathy, and sound professional judgment. With 5+ years of hands-on claims experience, you will lead thorough investigations, guide claim strategy, and ensure fair, timely resolutions. This role also offers a strong development pathway for advancement into more senior claim positions.

Responsibilities

• Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
• Establish reserves and/or provide reserve recommendations within established reserve authority levels.
• Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims.
• Negotiate any disputed bills or invoices for resolution.
• Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
• Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
• Absorb and supervise the selection, referral, and supervision of designated claim files sent to outside vendors (i.e. legal, surveillance, case management, etc.).
• Assess and monitor subrogation claims for resolution.
• Review and maintain personal diary on claim system.
• Client satisfaction. Prepare reports detailing claim status, payments and reserves, as requested.
• Compute disability rates in accordance with state laws.
• Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.
• Handle more complex and involved claims than lower level claim positions with minimum supervision.
• Conduct claim reviews and/or training sessions for designated clients, as requested.
• Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.

Qualifications

• Five or more years of Workers’ Compensation claims experience.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
• Adjuster’s license may be required based on jurisdiction.
• States handled: NJ, PA, MD, and DE (DE preferred).

Preferred Qualifications

• Bachelor’s degree is preferred but not required.
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.