Workers’ Compensation Adjuster

Overview We support 9 million customers and businesses nationwide with electric utilities in three states and natural gas distribution utilities in four, and provide wholesale energy, customized distributed energy solutions, fiber optics, and wireless communications across the country. This is a hybrid position with an in‑office presence expectation at 241 Ralph McGill Blvd, Atlanta, GA. Responsibilities Investigate, analyze, and manage workers’ compensation claims in Georgia for Georgia Power, Southern Company Services, Southern Power, and Southern Communications. Determine compensability; handle indemnity, medical, financial exposure, and payments. Complete required state and federal filings; collaborate with defense counsel on legal or litigation matters. Support subrogation, excess insurance, Subsequent Injury Trust Fund (SITF), and other claim‑related processes. Coordinate Medicare Set‑Aside reporting and funding; facilitate related arrangements and communications. Provide testimony at hearings, depositions, mediations, and other legal proceedings as required. Prepare or support settlement evaluations; negotiate settlements and manage settlement documentation. Support medical management activities such as bill review approvals, pharmacy benefit management requests, and processing of employee reimbursements. Utilize automation tools, including Power Automate, to streamline workflows. Manage or support a variety of claim types—medical‑only, lost‑time, complex medical, catastrophic, death, and litigated claims. Ensure compliance with state and federal reporting requirements, including Georgia State Board filings and Medicare reporting. Qualifications Education: High School Diploma or higher; an Associate or Bachelor’s degree is preferred. 1–3 years of experience in workers’ compensation, insurance, HR, claims administration, medical claims, or a related field. Knowledge of accepted industry standards and practices; willingness to learn workers’ compensation claim‑handling standards, compliance requirements, systems, and processes through on‑the‑job training. Preferred: additional workers’ compensation claim experience, including medical‑only, lost‑time, complex medical, litigated, or settlement‑related claims. Prior experience in claims, insurance, HR, medical billing, healthcare administration, or risk management. Experience evaluating compensability, exposure, reserves, return‑to‑work opportunities, settlement strategy, and claim resolution options. Strong written and verbal communication, effective note‑taking, and the ability to follow procedures. Business Acumen Problem‑solving skills and the ability to develop practical solutions in new, unique, or unfamiliar situations. Excellent communication skills; clear correspondence drafting and documentation of claim activity. Willingness and ability to learn workers’ compensation concepts, claim‑handling practices, and compliance requirements through training. Financial analysis of claim financials, including future reserve estimates. Manage calendars, diaries, and action plans to support timely claim handling and compliance with deadlines. Responsiveness to after‑hours calls on a limited basis. Availability to travel to off‑site meetings, conferences, hearings, mediations, training opportunities, or other business needs. Builds and maintains strong professional relationships and collaborates with internal and external stakeholders. Functional Expertise Partners with employees, leadership, medical providers, vendors, and legal counsel to manage and resolve claims. Determines compensability in accordance with Georgia workers’ compensation laws and company policies. Collaborates with external defense counsel to investigate claims and evaluate compensability. Manages or supports a broad range of claim types, including medical‑only, lost‑time, complex medical, catastrophic, death, and litigated claims. Applies professional judgment for complex claim issues and seeks guidance when appropriate. Communicates with Payroll to ensure proper handling of indemnity offsets and salary‑in‑lieu payments. Calculates, analyzes, and manages claim financials, including historical spend and future reserve estimates. Ensures timely and accurate processing of payments—indemnity, medical, legal, and related expenses. Identifies and pursues claim resolution opportunities, return‑to‑work strategies, settlements, and benefit discontinuation. Evaluates cost containment opportunities while ensuring quality medical care. Coordinates reimbursement and recovery efforts, including excess insurance, SITF, and subrogation. Maintains accurate and detailed claim documentation, notes, diaries, and action plans. Ensures compliance with all state and federal reporting requirements, including Georgia State Board filings and Medicare reporting. Supports required annual filings for the State Board of Workers’ Compensation and the Self‑Insured Guaranty Trust Fund. Facilitates Medicare Set‑Aside reporting and funding. Manages vendor setup processes, W‑9s, and billing information for payment processing. Supports medical management activities such as bill review approvals, pharmacy benefit requests, and employee reimbursement processing. Uses automation tools, such as Power Automate, to streamline workflows. Builds and maintains strong vendor relationships, ensuring timely communication and issue resolution. Serves as a cross‑trained resource for processes related to the Panel of Physicians, Medicare reporting, third‑party discovery requests, and other administrative tasks. Provides training and support to other team members on cross‑trained processes. Litigation Represents the company in hearings, depositions, mediations, and other legal proceedings. Partners with defense counsel by providing documentation and case strategy support. Prepares and supports settlement evaluations; participates in negotiations. Evaluates claims for closure opportunities and develops resolution strategies. Negotiates settlements with pro‑se claimants and supports counsel with settlement documentation. Coordinates subrogation efforts with insurers and legal representatives when third‑party liability exists. Communicates with opposing counsel and manages legal expense costs. Southern Company is an equal opportunity employer where an applicant's qualifications are considered without regard to race, color, religion, sex, national origin, age, disability, veteran status, genetic information, sexual orientation, gender identity or expression, or any other basis prohibited by law. Job Identification: 20156 Job Category: Human Resources Job Schedule: Full time Company: Georgia Power #J-18808-Ljbffr JobPath Partners LLC