Senior Workers Compensation Claims Adjuster

Lodestar Claims & Risk Services•Phoenix, AZ

8h•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 and works toward appropriate outcomes in a timely manner and in accordance with applicable statutes, policy provisions, and company guidelines.

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 Arizona and Indiana jurisdictions.
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.
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 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 suspect claims.
Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
Establish reserves with documented rationale and maintain or adjust them over the life of the claim to reflect changes in exposure.
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 loss outcomes.
Maintain working knowledge of jurisdictional requirements and applicable case law for each state serviced.
Demonstrate technical proficiency through timely, 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 interactions during claims reviews, stewardship meetings, and similar account-specific sessions.
Authorize treatment according to 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 the job.