Job Description
Mid-Atlantic Workers Compensation Claims Adjuster - Remote
Job Summary
- Seeking a skilled and detail-oriented Workers Compensation Claims Adjuster for a remote position.
- This role focuses on analyzing, investigating, and resolving workers' compensation claims while providing exceptional service to policyholders, claimants, and business partners.
- Candidates should have a strong understanding of workers' compensation laws specific to the Mid-Atlantic region and demonstrate a commitment to accuracy, efficiency, and integrity.
- This position offers the flexibility to work from home and contribute to effective claims solutions.
Responsibilities
- Investigate and evaluate workers’ compensation claims to determine coverage, compensability, liability, and benefits owed.
- Conduct detailed reviews of medical records, employment records, and other documentation to assess claims.
- Interpret and apply Mid-Atlantic workers' compensation laws, statutes, and regulations.
- Communicate effectively with injured employees, employers, medical providers, attorneys, and internal stakeholders to ensure the timely resolution of claims.
- Authorize treatment and payments within designated authority levels while ensuring compliance with company policies and applicable state laws.
- Handle claim settlements, reviews, and negotiations in a fair and ethical manner.
- Prepare and deliver reports documenting claim activity, reserve adequacy, and resolution strategies.
- Evaluate ongoing medical treatment plans and facilitate return-to-work options when feasible.
- Collaborate with legal teams as needed to support litigation and dispute resolution efforts.
- Maintain accurate and up-to-date claim records in accordance with organizational policies and compliance requirements.
Qualifications/Requirements
Education & Experience
- High school diploma or equivalent required; Bachelor’s degree in a related field preferred.
- Minimum of 3-5 years of experience as a workers' compensation claims adjuster or related role.
Licensing & Certification
- Must hold a valid claims adjuster license in at least one Mid-Atlantic state (e.g., VA, MD, DE, PA, NJ) and be eligible for any additional licensing as required.
- Relevant industry certifications (e.g., AIC, CPCU) are a plus.
Knowledge & Skills
- In-depth knowledge of Mid-Atlantic workers' compensation regulations, industry standards, and best practices.
- Strong analytical and problem-solving skills with the ability to make sound decisions.
- Clear communication and interpersonal skills with a focus on empathy and diplomacy.
- Proficiency in using claims management software, as well as Microsoft Office Suite (Word, Excel, Outlook).
- Strong organizational and time management skills with the ability to manage a high-volume caseload.
Core Competencies
- Proven ability to work independently within a remote environment.
- Strong ethical conduct and ability to handle sensitive information with integrity.
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