Workers Compensation Adjuster
Posted 11hrs ago
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Workers’ Compensation Adjuster managing State Act claims for AvonRisk, a specialty risk manager serving self-insured organizations. Determining compensability, administering benefits, negotiating resolutions, and coordinating litigated claims.
Responsibilities:
- Receive newly reported claims
- Determine coverage under the State Workers’ Compensation Act and exposure to LHWCA
- Maintain and update claim notes throughout the claim lifecycle
- Record claim information in an electronic database
- Interview claimants, insureds, medical professionals, and witnesses to determine claim validity
- Communicate claim compensability decisions to claimants, employers, and medical providers
- Set appropriate reserves based on the nature and extent of injuries
- Calculate lost-time wages and make disability payments to claimants
- Report mandatory claims data to state entities within required timeframes
- Order independent medical examinations and prepare documentation for physician review
- Maintain correspondence with claimants, insureds, clients, and nurse case managers
- Review and process medical bills for additional discount opportunities
- Collaborate with claimants, clients, and insureds to pursue early return-to-work outcomes
- Partner with legal counsel on litigated claims and provide documentation for defense
- Attend settlement conferences, mediations, and hearings on behalf of the insurance company
- Review and approve defense attorney bills within authority
- Work with underwriting on loss information for renewal rates and with Risk Management to identify trends
- Respond to state requests for health cost disputes, hearing applications, and penalty assessment letters
- Identify subrogation potential and pursue recovery
- Lead claim reviews with clients as requested
Requirements:
- 5+ years experience handling CT, DE, MD, CA, NJ, PA, RI Workers Compensation claims
- Multi-state Adjuster license
- Experience in, and hold a current adjusters license to handle WC claims in CT, DE, MD, CA, NJ, PA, RI - preferred
- High School education
- Proficiency in entire Microsoft Office suite
- Knowledge of relevant workers’ compensation laws
- Strong grasp of medical terminology
- Familiarity with medical cases and how treatment typically progresses
- Excellent professional oral and written communication abilities
- Attention to detail and good organization skills
- Ability to negotiate issues and settlements
- Strong focus on customer service, including timely response to requests/inquiries
- Ability to adapt to changing technologies and learn new equipment and systems
- Ability to establish and maintain effective working relationships with others
Benefits:
- Comprehensive medical, dental, and vision benefits
- Company contributions to HSA and FSA plans
- Employer-paid life and disability insurance
- 401(k) with company match
- Paid time off (PTO) and company-paid holidays
- Employee assistance resources
- Supportive culture that values balance and wellbeing
- Full benefits package
Similar Jobs
117d
Senior Workers' Compensation Adjuster
Senior Workers’ Compensation Adjuster managing moderate to complex claims including investigation, negotiation, and litigation remotely. Seeking candidate with 5+ years California claims experience.
117d
No more related jobs available.