Analysis Skills, Best Practices, Brokerage, Claims Management, Claims Processing, Communication Skills, Documentation, Establish Priorities, File Maintenance, Healthcare Providers, Insurance, Insurance Claims, Maintain Compliance, Negotiation Skills, People Management, Presentation/Verbal Skills, Regulations, Regulatory Requirements, Reporting Skills, Time Management, Writing Skills
Contract Duration: 3 months, possible extension
Location: Portland, OR
Work Arrangement: Hybrid
Position Overview
We are seeking an experienced Claims Adjuster IV to manage workers’ compensation claims from investigation through resolution. This role requires strong analytical, communication, and decision-making skills to evaluate claims, determine liability, negotiate settlements, and ensure timely claim resolution while maintaining compliance with applicable policies and regulations.
Key Responsibilities
- Review claim and policy information to determine coverage, liability, and claim exposure.
- Conduct thorough investigations by gathering facts, interviewing claimants, insureds, witnesses, attorneys, medical providers, and other relevant parties.
- Analyze claim details and documentation to assess liability and determine appropriate claim outcomes.
- Prepare detailed reports documenting investigations, evaluations, settlements, denials, and claim activity.
- Establish and manage claim reserves within assigned authority levels and recommend adjustments when necessary.
- Identify and escalate unusual or potentially high-exposure claims.
- Negotiate and settle claims fairly, accurately, and in a timely manner.
- Obtain necessary documentation, including releases, proofs of loss, and settlement agreements.
- Issue claim payments and communicate claim decisions to customers, claimants, attorneys, and other stakeholders.
- Maintain accurate claim files and ensure adherence to established claims handling practices.
Qualifications
Required
- 2+ years of experience handling Workers’ Compensation claims.
- Strong investigative, analytical, and decision-making abilities.
- Excellent verbal and written communication skills.
- Ability to build professional relationships with claimants, insureds, brokers, attorneys, medical providers, and other stakeholders.
- Self-motivated with the ability to manage a workload independently and prioritize effectively.
- Knowledge of workers’ compensation claims processes, insurance coverages, and policy interpretation.
Preferred
- Experience managing complex or higher-exposure workers’ compensation claims.
- Familiarity with claim reserve management and settlement negotiations.
- Understanding of industry best practices and regulatory requirements related to claims handling.
Education & Experience
- Bachelor’s degree preferred; equivalent workers’ compensation insurance experience will also be considered.
- Relevant claims handling experience in a workers’ compensation environment.
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