Workers’ Compensation Claims Adjuster (KY Dedicated Account)

Job Summary

The Workers’ Compensation Claim Consultant investigates, evaluates, and adjusts claims in accordance with established claim handling standards and laws. This role manages claims from assignment through resolution, including those with litigation exposure, while ensuring compliance with CCMSI claim handling standards, client-specific instructions, and Kentucky jurisdictional requirements. This is a full life-cycle WC adjuster role designed for experienced adjusters with 5+ years of workers’ compensation claim handling experience.

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.
• Assist in 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.
• 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.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• 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

• Minimum of 3 years of workers’ compensation claim handling experience.
• Experience managing claims in Kentucky workers’ compensation jurisdiction.
• Exposure to litigated workers’ compensation claims.
• Strong analytical, decision-making, and negotiation capabilities.
• Excellent verbal and written communication skills.
• Ability to work independently with strong organizational and time management skills.
• Proficiency in Microsoft Office applications.
• Reliable, predictable attendance during assigned client service hours.

Preferred Qualifications

• Prior TPA experience.
• Experience handling governmental or public entity accounts.
• Advanced experience managing complex or high-exposure claims.
• Knowledge of KY Managed Care plans.