Job Description

Job Description

Job Description

Job Profile

Job Title: Claims Adjuster

Location: Remote in the US

Hire Type: Contingent

Pay Range: $30

Work Model: Remote

Work Shift: Monday-Friday 8 am – 4 pm

Recruiter Contact: Sean Craft I sean@marykraft.com I 443-345-3305

Nature & Scope:

Positional Overview

We are seeking an experienced Workers Compensation Claims Adjuster to handle mid- to high-level claims involving both medical and indemnity components. The Claims Adjuster will be responsible for analyzing claims, determining benefits due, ensuring adjudication is in accordance with company standards and best practices, managing subrogation opportunities, and negotiating settlements. This role requires exceptional attention to detail, strong communication skills, and a solid understanding of state regulations.

Role & Responsibility:

Tasks That Will Lead to Your Success

• Determine compensability and benefits due to long-term indemnity workers compensation claims.
• Monitor reserve accuracy and files all required documentation with state agencies.
• Develop and manage claim action plans through resolution, including return-to-work coordination.
• Approve and process assigned claims and manage action plans in line with claim or client contracts.
• Identify and pursue subrogation opportunities; negotiate settlements.
• Maintain regular communication with claimants and clients to provide updates on claim status.
• Ensure claim files are properly documented and coded correctly.
• Process complex lifetime medical or defined period medical claims, including state filings and treatment decisions.
• Maintain strong professional relationships with clients.

Skills & Experience

Qualifications That Will Help You Thrive

• High School Diploma or GED required; bachelor’s degree preferred.
• Active Workers Compensation Adjuster licenses in Oklahoma (OK) and Louisiana (LA) are required.
• Minimum of 2+ years recent and relevant workers compensation claims experience (medical and indemnity).
• Four (4) years of claims management experience preferred, or equivalent combination of education and experience.
• In-depth understanding of workers compensation regulations, medical management practices, and claim procedures.
• Knowledge of disability duration, offsets, deductions, and Social Security/Medicare processes.
• Strong analytical, negotiation, and organizational skills.
• Excellent verbal and written communication abilities.
• Proficiency in Microsoft Office and claims management software.
• Ability to work independently and collaboratively in a team environment.
• Commitment to meeting or exceeding service expectations.

Job Tags

Similar Jobs