Senior Claims Specialist

Optech, LLC
  • Michigan, MI
    8 days ago

    Job Description

    We are seeking a Michigan Workers" Comp Indemnity Adjuster. This is a direct hire position.

    RESPONSIBILITIES:

    We are seeking an experienced Indemnity Adjuster to manage a complex workers' compensation desk with a strong emphasis on Michigan lost-time and litigated claims. This role handles primarily indemnity and complex files, with limited medical-only exposure, and requires collaboration with internal leadership and external stakeholders to ensure high-quality, compliant claim outcomes.

    • Demonstrate strong working knowledge of Michigan Workers' Compensation regulations and practices
    • Investigate claims, determine compensability, establish reserves, and manage ongoing exposure
    • Coordinate medical care, wage loss benefits, and return-to-work efforts
    • Communicate effectively with all stakeholders, including attorneys, injured workers, employers, carriers, and medical providers
    • Utilize claims management systems to document activity, manage workflows, and meet service expectations
    • Adhere to quality standards, production benchmarks, and client service level agreements (SLAs)
    • Participate in internal reviews, audits, and performance evaluations

    Performance Measures

    • Compliance with quality and accuracy standards
    • Meeting production expectations for claim handling and resolution
    • Adherence to client service level agreements (SLAs)

    Stakeholders

    • External: Defense attorneys, injured workers, employers, clients, carriers, medical providers
    • Internal: Supervisor, Manager, Account Manager

    QUALIFICATIONS:

    Experience & Knowledge

    • 2-3 years of workers' compensation claims experience, with a strong focus on indemnity and lost-time claims
    • Extensive Michigan workers' compensation experience required
    • Prior experience handling litigated claims is required

    Licenses & Education

    • Michigan Adjuster's License required

    • Reciprocal licenses (Florida or Texas) accepted

    • Bachelor's degree or equivalent relevant work experience Technical Skills

    • Proficiency in Microsoft Office (Teams, Outlook/Email, Word)

    • Experience using CareMC claims system preferred (not required)

    • Strong documentation, organization, and time-management skills

    Numbers & Facts

    LocationMichigan, MI

    Skills

    • Benchmarkingunmatched
    • Claims Managementunmatched
    • Claims Processingunmatched
    • Communication Skillsunmatched
    • Customer Support/Serviceunmatched
    • Healthcare Providersunmatched
    • Internal Auditunmatched
    • Leadershipunmatched
    • Litigationunmatched
    • Patient Careunmatched
    • People Managementunmatched
    • Performance Analysisunmatched
    • Performance Metricsunmatched
    • Performance Reviewsunmatched
    • Quality Metricsunmatched
    • Regulationsunmatched
    • Sales Managementunmatched
    • Service Level Agreement (SLA)unmatched
    • Worker's Compensationunmatched

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