Workers Comp Subrogation - Sr Adjuster Service Claims

Hanover Insurance Group•Worcester, MA

1d•Hybrid

About The Position

The Sr Adjuster Service Claims is responsible for independently managing moderate to complex and high-value workers compensation claims across multiple lines of business. This role requires advanced investigation, evaluation, and negotiation skills to resolve claims involving personal and commercial customers. It involves thorough analysis, collaboration with internal teams and external experts, and proactive identification of recovery opportunities. Strong technical expertise and the ability to manage claims in accordance with policy provisions, regulations, and best practices are essential to delivering high-quality service and outcomes.

Requirements

Bachelor’s degree or equivalent experience with claim handling.
Typically requires 5–10 years of adjusting experience.
Ability to read and interpret programs, special accounts and policies.
Strong working knowledge of applicable statues, regulations, case law, and third-party legal liability concepts.
Operates independently with sound judgement and decision-making within defined authority levels.
Demonstrates sound judgment and decision-making on high-exposure cases, including litigation and compliance matters.
Communicates clearly and effectively in both verbal and written formats across a variety of situations.
Selects appropriate communication channels and consistently demonstrates empathy toward all stakeholders.
Maintains comprehensive and organized claim records and prepares detailed reports summarizing findings and recommendations.
Highly organized with the ability to manage complex workflows and project work.
Demonstrates strong time management and desk management skills.
Makes informed decisions based on thorough analysis of complex issues.
Evaluates risks and outcomes, acts independently within authority, and identifies patterns in claims to support resolution strategies.
Ability to collaborate with internal and external experts, including legal, underwriting, and other stakeholders to ensure thorough evaluation.
Ability to quickly assess customer concerns and anticipate questions, communicate and translate complex and technical terms clearly with easily understood language; deliver difficult messages when needed.
Skilled in using claims systems and Microsoft Office Suite.
Ability to use a personal computer and other standard office equipment.
Ability to sit and/or stand for extended periods.
Required to work on-site as needed.
Ability to travel as necessary.
Ability to work in a fast paced, changing or stressful environment.
Ability to perform work in a noisy/loud work environment.
May be required to have and maintain sufficient home-based internet connection.

Responsibilities

Independently manage complex service claims with significant exposure.
Lead thorough investigations, assess coverage, and issue appropriate documentation including reservation of rights and coverage letters.
Escalate issues as needed.
Identify and proactively pursue opportunities to transfer risk to the appropriate entities for the benefit of insureds and business partners.
Maintain comprehensive and detailed claim records.
Identify and assign Subro potential appropriately; set up file to support successful recovery efforts.
Ensure all claims activities comply with regulatory and company standards.
Execute jurisdictional compliance requirements and support others in understanding regulatory obligations.
Manage suspicious claims, using advanced techniques and tools, and refer them to the Special Investigation Unit as needed.
Set reserves, authorize payments, and make financial decisions within authority and contribute to reserving accuracy and efficiency.
Coordinate with internal and external stakeholders including legal, underwriting, vendors, and agents.
Lead cross-functional meetings and communicate complex information clearly to diverse audiences.
Use advanced tools and analytics to identify trends, correct inconsistencies, and improve claims handling efficiency.
Ensure proper data ingestion, labeling, and protection of personally identifiable information (PII).
Serve as a mentor to junior adjusters, providing guidance on complex claims, compliance, and litigation processes.
Support training initiatives and contribute to the development of best practices and educational materials.
Deliver empathetic, clear communication throughout the claims process.
Educate claimants and stakeholders, affirm next steps, and ensure a positive customer experience.
Represent the company in mediations, arbitrations, and trials.
Support subrogation efforts through proactive evaluation and coordination with recovery partners, while contributing insights on trends, risks, and process improvements.
Ensure compliance with all licensing requirements.