Job Description

Workers' Compensation Claims Adjuster

Job Summary:
Seeking an experienced Workers’ Compensation Claims Adjuster to manage the full lifecycle of injury-related claims. This role involves evaluating coverage, determining compensability, negotiating resolutions, and collaborating with injured employees, employers, legal representatives, and medical professionals to ensure efficient and compliant claim handling.

Responsibilities:

• Receive and initiate handling of newly reported claims
• Determine compensability and coverage based on investigation and documentation
• Maintain accurate claim notes and records throughout the life of each claim
• Conduct interviews with claimants, employers, medical providers, and witnesses to verify claim details
• Communicate claim decisions to all involved parties
• Set and adjust reserves appropriately based on injury severity and case development
• Calculate and schedule maintenance payments; manage ongoing diaries for future payments
• Coordinate return-to-work efforts and maintain regular communication with all stakeholders
• Review and process medical bills for additional discount opportunities through internal systems
• Collaborate with defense counsel on litigated claims, supplying required documentation and case updates
• Review and approve legal invoices within designated authority levels
• Lead client-facing claim reviews as requested

Qualifications/Requirements:

• 3–5 years of Jones Act claims adjusting experience required
• In-depth knowledge of Federal Jones Act regulations
• Strong understanding of medical terminology and treatment progression
• Proficiency in Microsoft Office applications
• Excellent written and verbal communication skills
• Strong organizational skills and attention to detail
• Demonstrated negotiation and settlement abilities
• Commitment to high-quality customer service and timely communication
• Ability to adapt to new technologies and claims systems
• Ability to build and maintain effective working relationships across internal and external stakeholders

Compensation Package:

• Compensation: Between $75K - $100K (based on experience)
• Competitive benefits package, paid time off, professional development opportunities, etc.

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

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