Claims Adjuster - Workers Compensation - Remote / Telecommute

Workers’ Compensation Claims Specialist

Pay Range: $45hr - $50hr

Requirement/Must Have:

• Strong experience handling workers’ compensation claims.
• Knowledge of workers’ compensation laws, regulations, and claim procedures.
• Strong analytical and investigative skills.
• Experience managing complex and technically difficult claims.
• Ability to negotiate settlements within authority limits.
• Strong communication and interpersonal skills.
• Ability to maintain accurate and detailed claim documentation.
• Strong organizational and time management skills.
• Ability to work independently and manage multiple claims simultaneously.

Experience:

• Minimum 5 years of claims management experience or equivalent combination of education and experience required.
• Experience handling workers’ compensation claims required.
• Experience with litigation management and claim resolution.
• Experience managing reserves, settlements, and benefit calculations.
• Experience preparing state filings and maintaining compliance with statutory requirements.
• Experience coordinating investigations, vendor referrals, and legal support services.
• Experience with cost containment strategies and vendor management preferred.
• Experience managing claim recoveries including subrogation and offsets preferred.

Responsibilities:

• Analyze and process workers’ compensation claims through investigation and information gathering.
• Develop and implement action plans for timely and effective claim resolution.
• Negotiate settlements within assigned authority levels.
• Calculate and maintain appropriate claim reserves throughout the claim lifecycle.
• Calculate and process benefit payments, claim adjustments, and settlements.
• Prepare and submit required state filings within statutory deadlines.
• Manage litigation activities and ensure cost-effective claim resolution.
• Coordinate vendor referrals for investigations and litigation support.
• Apply cost containment techniques and strategic vendor partnerships to reduce claim costs.
• Manage claim recoveries including subrogation and applicable offsets.
• Report claims to excess carriers and respond to requests in a timely and professional manner.
• Communicate claim activity and status updates to claimants and clients.
• Maintain accurate claim documentation and coding.
• Refer claims and issues to supervisors or management as appropriate.
• Support organizational quality initiatives and compliance standards.
• Travel as required to support claim activities and investigations.

Should Have:

• Strong decision-making and problem-solving abilities.
• Excellent customer service and client relationship management skills.
• Ability to work under deadlines and manage high-volume caseloads.
• Strong attention to detail and accuracy.
• Professional and ethical work approach.
• Ability to collaborate effectively with legal teams, vendors, and stakeholders.

Skills:

• Workers Compensation Claims.
• Claims Investigation.
• Litigation Management.
• Claims Negotiation.
• Reserve Management.
• Benefit Administration.
• Subrogation.
• Claims Documentation.
• Regulatory Compliance.
• Cost Containment.
• Vendor Coordination.
• Risk Assessment.
• Claims Resolution.
• Customer Service.
• Case Management.

Qualification and Education:

• Bachelor’s degree from an accredited college or university preferred.
• Professional certifications related to claims or insurance preferred.
• Equivalent combination of education and relevant experience may be considered.