Senior Workers Compensation Claims Adjuster

Lodestar Claims & Risk Services•Whitpain Township, PA

5h•Remote

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, including complex and highest-risk claims. The role administers claims in a timely manner in accordance with applicable statutes, policy provisions, and company guidelines, while working with clients, internal teams, and service providers to achieve appropriate claim outcomes.

Requirements

Bachelor’s degree or four or more 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 Pennsylvania 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 demonstrated ability to work independently and manage multiple tasks simultaneously.
Proven critical-thinking skills, including 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 products such as Word, Excel, and PowerPoint.
Ability to travel for business purposes, approximately less than 10%.

Nice To Haves

Associate in Claims (AIC) designation or similar professional designation.

Responsibilities

Promptly investigate assigned claims with minimal supervision, including complex claims.
Determine coverage, compensability, potential subrogation recovery, and eligibility for the second injury fund when applicable.
Alert the Supervisor and Special Investigations Unit to potentially suspicious 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 as exposure changes.
Negotiate claim 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 claim outcomes.
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 regarding claims and account issues.
Provide a high degree of customer service to clients, including face-to-face interactions during 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.
Follow the Company’s Code of Business Conduct and Ethics and apply relevant compliance policies, procedures, standards, and laws in performing job responsibilities.