Claims Adjuster, Worker's Compensation [Remote]

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims Adjuster, Worker's Compensation based in the United States.

This role offers the opportunity to deliver high-quality claims management and create exceptional experiences for small business customers. As a Workers’ Compensation Claims Adjuster, you will independently manage claims from initial setup through resolution while ensuring accurate decisions, compliance, and positive outcomes. You will investigate claims, evaluate exposure, coordinate with internal and external partners, and identify opportunities to improve claim outcomes. The position combines technical claims expertise, customer service, problem-solving, and operational improvement within a technology-driven insurance environment. The ideal candidate is detail-oriented, collaborative, and passionate about helping businesses navigate complex insurance processes. This remote opportunity allows you to make a direct impact on customer satisfaction and claims performance.

Accountabilities:

The Claims Adjuster, Workers’ Compensation will be responsible for managing the full lifecycle of workers’ compensation claims while ensuring compliance, effective communication, and optimal claim outcomes. This role requires strong judgment, analytical skills, and the ability to balance customer needs with claim management best practices.

• Independently manage workers’ compensation claims from initial setup through closure, ensuring timely and accurate handling throughout the claim lifecycle.
• Conduct thorough claim investigations, including timely three-point contact and ongoing evaluation as case circumstances evolve.
• Analyze claim exposure, determine compensability decisions, and make informed recommendations based on available facts and regulatory requirements.
• Establish and adjust reserves within assigned authority levels while ensuring accuracy and alignment with claim best practices.
• Manage medical and indemnity benefits administration in compliance with applicable state regulations and requirements.
• Monitor and control legal activity, collaborating with defense counsel to manage litigation processes, costs, and outcomes.
• Identify opportunities for early resolution, negotiate settlements, and pursue strategies that reduce claim exposure while achieving favorable results.
• Serve as a trusted point of contact for customers, agents, and business partners by providing claim guidance, updates, and support.
• Deliver excellent customer service while setting clear expectations throughout the claims process.
• Collaborate with third-party administrators, claims partners, and internal teams to improve claim outcomes and customer experiences.
• Identify operational improvements and contribute to enhancements in claims processes, procedures, and service standards.
• Maintain compliance with applicable statutory guidelines, regulatory requirements, and industry best practices.
• Support continuous improvement initiatives focused on claims quality, efficiency, and customer satisfaction.

Requirements:

The ideal candidate is an experienced workers’ compensation claims professional with strong knowledge of claim adjudication, investigation, and regulatory requirements. You should be comfortable managing complex claims independently while providing excellent service to customers and partners.

• High school diploma or equivalent required; bachelor’s degree or equivalent experience with college coursework preferred.
• Minimum of 2 years of workers’ compensation claims handling experience required.
• Experience managing workers’ compensation claims in states such as Florida, Georgia, North Carolina, South Carolina, and Tennessee preferred.
• Strong understanding of claims adjudication, medical management, litigation management, and settlement strategies.
• Knowledge of jurisdictional regulatory requirements and CMS/MSA guidelines.
• Ability to analyze complex claim information and make sound decisions to mitigate exposure while achieving positive outcomes.
• Strong problem-solving skills with the ability to manage priorities independently and work through complex situations.
• Excellent written and verbal communication skills, including the ability to explain complex information clearly.
• Strong customer service mindset with the ability to build effective relationships with internal and external stakeholders.
• Ability to collaborate effectively with claims partners, agents, customers, and cross-functional teams.
• Experience using collaboration tools such as G-Suite and Slack is preferred.
• Strong organizational skills and ability to manage multiple priorities in a remote work environment.

Benefits:

• Competitive annual salary range of approximately $70,000–$90,000 USD.
• Fully remote work opportunity within the United States.
• Competitive cash compensation package.
• Comprehensive health insurance plans.
• Generous paid time off.
• Future-focused 401(k) retirement plan with company match.
• Generous parental and caregiver leave benefits.
• Opportunity to contribute to a technology-driven insurance organization focused on improving the small business experience.
• Collaborative culture built around innovation, ownership, and continuous improvement.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

#LI-CL1

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.