Workers Compensation Claims Adjuster

Job Description

Job Description

We are seeking a Workers’ Compensation Claims Adjuster who handles workplace injury claims. The role involves investigating claims, evaluating damages, and settling cases fairly and quickly. The position focuses on supporting employees, protecting the organization, and providing strong customer service in a fast-paced environment.

Responsibilities:

• Reviews and analyzes reports of accidents including property damage and bodily injury to determine liability; reviews and analyzes Liability and/or Workers' Compensation claims and recommends appropriate action.
• Consults on injury cases with various medical personnel in order to ascertain the extent and cost of treatment, loss of earning capacity and prognosis; confers with County physician on employment limitations.
• Performs the calculation and payment of benefits whether indemnity and/or medical benefits, including entering all payments for benefits.
• Coordinates the gathering of formal evidence by taking photographs, preparing diagrams and making measurements at accident scene; arranges for witnesses to appear at legal proceedings; and prepares accident reports.
• For Workers Compensation claims the adjuster will contact the injured employee, employer, and medical provider to document the claim. For Liability claims the adjuster will contact the claimant, the division and any witnesses.
• Contacts injured employee, employer, and medical provider to document claim. Conducts field investigations, face-to-face statements with employees, employer representatives and witnesses to understand the nature of the claim and gain an understanding of what occurred prior to the claim.
• Negotiate claim settlements with the Director of Risk Management, the County Administrator, the County Attorney, claimants and/or their legal teams. Attend mediations with the County Attorney’s office to support the claims process.
• Provide advice regarding potential fraud, subrogation, and underwriting/safety risk, and communication with counsel.
• Authorizes/coordinates medical treatment with walk-in facilities and specialists to update claim.
• Analyze complex information from different sources, such as police reports, videos from surveillance cameras or audio, and other information to further understand the incident.
• Make decisions for approvals of medical treatments and property restoration. Make determinations on liability or compensability for Workers Compensation claims. Apportion percentage of liability and negotiate settlement with claimant or claimant's attorney or Liability Claims.

Qualifications:

• Requires two (2) years equivalent of higher-level education from an accredited college or university with major coursework in insurance, risk management, or closely related field. (One year of relevant experience may be substituted for each year of required education.)
• Requires four (4) years in adjusting workers' compensation and/or bodily injury/property damage liability claims or closely related experience.
• Adjuster license is required (6-20 License)

Schedule : Monday to Friday from 8:30 am to 5:00 pm