Workers Compensation Claims Adjuster

Job Description

Job Description

Job Profile  

Job Title:  Claims Adjuster

Location: Remote anywhere in US

Hire Type: Contingent 

Pay Range: $40 - $45 

Work Model:   Remote

Work Shift: Monday-Friday 8 am – 4:30 pm 

Recruiter Contact:   Sean Craft I View email address on ziprecruiter.com I View phone number on ziprecruiter.com

Nature & Scope:

Positional Overview

We are seeking an experienced  Workers’ Compensation Claims Adjuster to join our team for a contingent assignment. The ideal candidate will have 3–4 years of relevant Oregon workers’ compensation claims handling experience and preferably hold  Oregon certification . This role involves analyzing mid- to high-level claims, determining benefits due, ensuring compliance with state requirements, and managing claims through resolution while maintaining exceptional client and claimant communication.

Role & Responsibility:

Tasks That Will Lead  to Your Success

• Manage and adjudicate  workers’ compensation claims , including determining compensability, calculating benefits, and ensuring accurate reserves.
• Monitor and file all necessary  state-required documentation within statutory deadlines.
• Develop and implement detailed  action plans for timely claim resolution, including coordination of return-to-work efforts.
• Approve claim payments and settlements in accordance with authority guidelines.
• Identify and manage  subrogation opportunities and negotiate settlements to reduce client exposure.
• Maintain consistent communication with claimants, employers, medical providers, attorneys, and clients.
• Ensure  claim files are accurately documented and properly coded.
• Handle complex lifetime medical and defined-period medical claims, including reviewing state and physician filings and evaluating treatment recommendations from utilization reviews.
• Foster and maintain  professional client relationships and deliver high-quality service.

Skills & Experience

Qualifications That Will Help You Thrive

• High School Diploma or GED required.
• Bachelor’s degree preferred.
• Oregon certification preferred.
• 3–4 years of workers’ compensation claims handling experience in Oregon required.
• Equivalent combination of education and claims management experience will be considered.
• Strong understanding of Oregon  workers’ compensation regulations , offsets, and disability duration.
• Knowledge of  medical management practices and Social Security/Medicare procedures related to workers’ compensation.
• Excellent oral and written communication skills, including the ability to deliver professional presentations.
• Proficient in Microsoft Office and claims management software systems.
• Strong  analytical, organizational, and negotiation skills .
• Ability to work both independently and collaboratively in a team environment.
• Commitment to meeting and exceeding  service expectations .