Medical Work Comp Claims Adjuster

About the Medical Work Comp Claims Adjuster Role

Under general supervision and following standard procedures with independent judgment, you will investigate, evaluate, and resolve/dispose of workers compensation claims to determine the extent of company liability.

Essential Duties And Responsibilities

You will:

• Follow corporate policies, procedures, and fair claims handling practices.
• Investigate claims to determine their validity and extent of liability by corresponding with agents, insureds, claimants, witnesses and others.
• Review and evaluate documentation including applications, reports, and statements.
• Monitor claim outcomes through self-audit processes.
• Deliver superior customer service to policyholders and agents ensuring timely resolution of service issues.
• Ensure legal, regulatory and fair claims handling compliance.
• Set or recommend reserves based on investigation results.
• Manage, evaluate, and conclude claims within defined authority.
• Prepare and maintain claim reports.
• Interact extensively with insureds, agents, claimants, attorneys, and service providers through interviews, scene inspections, settlement conferences, or trials.
• Contribute as a member of project teams as required.
• Perform other duties as assigned.

Qualifications

Level 4: Two to four years of related experience and/or training; or an associate's degree from a two-year college/technical school; or an equivalent combination of education and experience. Applicants must be legally eligible to work in the United States. Note that visa sponsorship is not available for this position.

Key skills/competency

claims, investigation, evaluation, liability, compliance, documentation, customer service, interviews, audits, project