Senior Claims Adjuster

Senior Claims Adjuster - Job Description

Position Summary

The Senior Claims Adjuster is responsible for managing and resolving Workers' Compensation claims, primarily in Maryland, by investigating claims, determining compensability, coordinating medical care, and driving claims through to timely and cost-effective resolution. This role supports organizational goals by ensuring compliance with jurisdictional requirements, maintaining strong client relationships, and delivering high-quality, strategic claims management. The position is both operational and hands-on, requiring direct claim handling and collaboration with internal and external stakeholders.

Key Responsibilities

Functional Leadership & Ownership

• 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.

Hands-On Execution & Delivery


• Investigate, evaluate, and manage indemnity Workers' Compensation claims.

• Determine compensability through claim analysis and recorded statements.

• Coordinate and monitor medical treatment and return-to-work strategies.

• Calculate and issue indemnity payments and review medical billing for accuracy.

Reporting, Quality & Operational Support

• 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.

Cross-Functional Partnership & Integration

• 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.

Growth, Change & Special Initiatives

• 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.

Process Improvement & Best Practices

• 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.

Center of Excellence (COE) Contribution

• Contribute expertise in Workers' Compensation claims handling.

• Support development of best practices, documentation, and training resources.

• Align claim strategies with broader organizational capabilities and standards.

Accountability

• The role is accountable for delivering effective and compliant claim outcomes.

• Maintaining claim quality, accuracy, and documentation standards.

• Driving timely and cost-efficient claim resolution.

• Building strong relationships with clients and stakeholders.

• Demonstrating sound judgment and ownership in claim-level decision making.

Qualifications

Required

• High school diploma or GED required; 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.

Key Competencies

• Ownership & Accountability

• Data-Driven Decision Making

• Process Improvement

• Collaboration & Communication

• Change Agility

• Business Acumen