Workers’ Compensation Claims Adjuster I

Workers’ Compensation Claims Adjuster I

Requirements

• Strong organizational skills
• Attention to detail
• Ability to manage multiple files in a deadline-driven environment
• Proficiency in Microsoft Office (Word, Excel, Outlook)
• Familiarity with medical terminology for accurate claims processing and communication

Responsibilities

• Investigate and evaluate workers’ compensation claims for compensability, coverage, and appropriate benefit administration.
• Establish and maintain reserves based on case facts and jurisdictional guidelines.
• Communicate effectively with claimants, clients, medical providers, and legal counsel.
• Review and process medical bills, wage statements, and other claim-related documents.
• Issue timely and accurate payment of benefits in accordance with state regulations and company policies.
• Document all file activity clearly and thoroughly in the claim management system.
• Coordinate return-to-work efforts and monitor medical progress and treatment plans.

Preferred Qualifications

• Excellent written and verbal communication skills
• Analytical thinking with sound judgment in evaluating claims and making decisions
• Ability to work independently and collaboratively within a team setting
• High attention to detail and accuracy in documentation and benefit calculation
• 3 or more years of workers’ compensation claims experience, or equivalent industry experience, is preferred
• An Associate’s degree is preferred but not required