Claims Adjuster

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.