Sr. Workers' Compensation Adjuster

Commonwealth of Massachusetts•Boston, MA

About The Position

The Human Resources Division’s Workers’ Compensation Unit (HRD/WC) administers the Commonwealth of Massachusetts’ self-insured workers’ compensation program. The unit uses medical management to support employee recovery and return to work, with the goal of returning injured employees to gainful employment in a timely and efficient way. This is a confidential position requiring working knowledge of M.G.L. Chapter 152. The Senior Workers’ Compensation Adjuster manages lost-time and medical-only claims, maintains communication with agency contacts, processes payments and medical bills, and prepares cases for litigation when needed. The position may also conduct virtual or on-site claim reviews and training and work on special projects assigned by management.

Requirements

Working knowledge of M.G.L. Chapter 152.
At least four years of full-time, or equivalent part-time, experience in investigatory or law enforcement work, or regulatory administration work, or an equivalent combination of required experience and permitted substitutions.
A bachelor’s or higher degree may substitute for a maximum of two years of the required experience; education toward such a degree is prorated based on the proportion of requirements completed.

Nice To Haves

Two to three years of experience adjusting workers’ compensation claims under M.G.L. Chapter 152.
Ability to communicate clearly and concisely with appropriate detail, empathy, and professionalism.
Ability to build and maintain effective relationships with internal and external customers.
Ability to investigate claims by gathering and analyzing facts to determine compensability.
Ability to work with minimal supervision and direction.
Ability to maintain a professional demeanor in challenging situations.
Commitment to working in a team environment.
Ability to adhere to strict timelines and multitask flexibly in a fast-paced environment.

Responsibilities

Conduct initial three-point contact and maintain ongoing communication with agency contacts throughout the life of each claim.
Identify potential third-party or subrogation cases.
Maintain accurate records and payments.
Process medical bills at DIA rates.
Manage a caseload of lost-time and medical-only claims in accordance with M.G.L. Chapter 152.
Prepare cases for litigation when necessary.
Calculate indemnity rates, travel reimbursements, end-of-compensation dates, and other required adjustments and reimbursements.
Create and monitor a personal diary system.
Conduct virtual or on-site workers’ compensation claim reviews or training for internal and external customers.
Work on special projects as assigned by the management team.