Senior Workers Compensation Claims Adjuster
About The Position
As a member of the claims team, the Senior Workers Compensation Claims Adjuster independently investigates, evaluates, and resolves assigned workers compensation claims of a more complex nature to achieve appropriate outcomes. The position administers and resolves high-risk claims in a timely manner and in accordance with legal statutes, policy provisions, and company guidelines. The role requires strong claims judgment, knowledge of applicable jurisdictional requirements, effective communication with internal and external parties, and a high degree of customer service. The position is remote and may require business travel of approximately less than 10%.
Requirements
- Bachelor's degree or at least four years of equivalent work experience in an insurance-related industry.
- At least 3–5 years of experience handling lost-time workers compensation claims.
- Past experience with California jurisdiction.
- Active license, or ability to obtain a license within 90 days of employment in mandated states.
- Familiarity with medical terminology and/or Workers' Compensation.
- Strong organizational skills and the ability to work independently and manage multiple tasks simultaneously.
- Critical thinking skills demonstrating analysis, judgment, sound decision-making, and attention to detail.
- Strong verbal and written communication and customer service skills.
- Computer literacy, including working knowledge of Microsoft Office applications such as Word, Excel, and PowerPoint.
- Ability to travel for business purposes, approximately less than 10%.
Nice To Haves
- SIP certification is strongly preferred.
- Associate in Claims (AIC) designation or a similar professional designation is desired.
Responsibilities
- Promptly investigate assigned claims, including complex claims, with minimal supervision.
- Determine coverage, compensability, potential subrogation recovery, and second injury fund applicability.
- Alert the Supervisor and Special Investigations Unit to potentially suspect claims.
- Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
- Establish appropriate reserves with documented rationale and maintain or adjust reserves throughout the claim to reflect changes in exposure.
- Negotiate claims settlements with client approval.
- Establish and implement action plans for case resolution, including medical and disability management, litigation management, negotiation, and disposition.
- Collaborate with Lodestar nurse professionals to develop and execute return-to-work strategies.
- Select and manage service vendors to balance allocated expenses and loss outcomes appropriately.
- Maintain working knowledge of jurisdictional requirements and applicable case law for each state serviced.
- Demonstrate technical proficiency through timely and consistent execution of best claim practices.
- Communicate effectively, verbally and in writing, with internal and external parties about claims and account issues.
- Provide a high degree of customer service to clients, including face-to-face participation in claims reviews, stewardship meetings, and similar account-specific sessions.
- Authorize treatment based on protocols established by statute or the Lodestar Managed Care department.
- Assist Lodestar clients by suggesting panel provider information in accordance with applicable state statutes.
- Comply with the Company’s Code of Business Conduct and Ethics and apply relevant compliance policies, procedures, standards, and laws in performing work.
- Travel for business purposes as needed, approximately less than 10%.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
