Lost-Time Claims Adjuster

SteadPoint•Birmingham, AL

1d•$55,000 - $90,000

About The Position

The Claims Adjuster with SteadPoint Risk Management Solutions is responsible for administering and managing workers' compensation claims from initial report through closure. This includes evaluating compensability, conducting thorough investigations, obtaining recorded statements from claimants and witnesses, coordinating medical treatment, facilitating return-to-work efforts, assigning legal counsel when appropriate, and overseeing the delivery of workers' compensation benefits. The Claims Adjuster ensures claims are handled efficiently, accurately, and in compliance with applicable regulations, industry standards, and company guidelines. This position operates with a high degree of independence and authority while handling claims involving significant complexity and specialized technical expertise. Responsibilities include evaluating claim exposure, establishing and maintaining appropriate reserves, directing claim strategy, and guiding claims toward timely resolution or settlement. The Claims Adjuster must possess a thorough understanding of insurance coverage, claims administration practices, medical terminology, and applicable laws, regulations, and case law that may impact claim outcomes. Success in this role requires exceptional analytical, negotiation, decision-making, and problem-solving skills, along with the ability to effectively organize and prioritize a diverse caseload. The Claims Adjuster must build and maintain productive relationships with claimants, clients, medical providers, attorneys, and other stakeholders through strong interpersonal and communication skills. This individual handles sensitive and confidential information with professionalism and discretion, serves as a trusted technical resource within the Claims Department, and provides guidance and support to team members as needed. A commitment to following established company policies, procedures, and evolving business practices is essential.

Requirements

Knowledge of applicable state laws relating to workers' compensation
Experience within Core Footprint (AL, GA, MS, TN, AR, NC, & SC) and willingness to learn new jurisdictions
Equivalent insurance claims
Workers' Compensation experience

Nice To Haves

Preferred bachelor's degree with 5 years' experience or 10 years' experience without a degree

Responsibilities

Manage a large inventory of complex claims to evaluate compensability/liability.
Plans and conducts complex claims investigations to confirm coverage and to determine liability, compensability and damages.
Analyzes and negotiates appropriate claim settlement/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials.
Conveys complex information regarding coverage and settlements to insureds, claimants, and external partners.
Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner.
Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements.
Receipt, review, and analyze incoming claims.
Produce necessary documentation for justification of compensability and/or denial of claim.
Must be able to answer, service, and document calls pertaining to policy benefits and determine whether the call needs to be referred to a supervisor.
Take statements of injured worker, insured, potential witnesses, as necessary, in the scope of investigative duties of the claim.
Process lost time benefits and coordinate meds, assign nurse case management, assign legal counsel if deemed necessary, and/or surveillance when appropriate.
Coordinate, review & ensure compliance to all state WC Board, EDI, CMS, NCCI, etc. reporting.
Assign independents and experts for onsite inspection and expert opinions regarding potential subrogation possibilities on serious claims.