Workers' Compensation Claims Adjuster

Ccmsi • Okemos, MI

20h • Hybrid

About The Position

We are seeking an experienced Workers’ Compensation Claim Adjuster to manage a dedicated Ohio workers’ compensation client account while working hybrid out of our Okemos, MI branch office. This role is responsible for full cradle‑to‑grave claims handling, including investigation, strategy development, medical management, reserving, and claim resolution within a fast‑paced TPA environment. Although the position is based in Michigan, the adjuster will handle Ohio workers’ compensation claims exclusively and partner closely with Ohio‑based clients and internal teams. Prior Ohio WC experience is preferred; however, candidates with strong workers’ compensation adjusting backgrounds who demonstrate a willingness and ability to learn the Ohio jurisdiction are strongly encouraged to apply. This role requires 1–2 trips annually to Cleveland, OH for client meetings, claim reviews, or training. The ideal candidate brings solid technical expertise, independent judgment, and the ability to manage a high‑volume caseload while delivering exceptional service to clients and injured workers.

Requirements

• 5+ years of workers’ compensation claims handling experience
• Ability to independently manage a full caseload of WC claims from initial report through resolution
• Strong knowledge of compensability investigation, medical management, reserving, and litigation oversight
• Experience interpreting state WC laws, benefit structures, and regulatory timelines
• Ability to communicate effectively with injured workers, employers, attorneys, medical providers, and client representatives
• Strong documentation, organization, and time‑management skills
• Ability to consistently meet deadlines and quality standards in a fast‑paced environment
• Proficiency with claim management software and Microsoft Office
• Ability to exercise sound, defensible judgment and maintain professionalism under pressure

Nice To Haves

• Experience working within a TPA environment is helpful
• Bachelor’s degree is preferred but not required.
• Bilingual (Spanish) proficiency — highly valued for communicating with claimants, employers, or vendors, but not required.

Responsibilities

• Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
• Establish reserves and/or provide reserve recommendations within established reserve authority levels.
• Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims.
• Negotiate any disputed bills or invoices for resolution.
• Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
• Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
• Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
• Assess and monitor subrogation claims for resolution.
• Review and maintain personal diary on claim system.
• Client satisfaction.
• Prepare reports detailing claim status, payments and reserves, as requested.
• Compute disability rates in accordance with state laws.
• Effective and timely coordination of communication with clients, claimants and appropriate parties throughout the claim adjustment process.
• Prepare newsletter articles, as requested.
• Provide notices of qualifying claims to excess/reinsurance carriers.
• Handle more complex and involved claims than lower level claim positions with minimum supervision.
• Conduct claim reviews and/or training sessions for designated clients, as requested.
• Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy)
• 10 paid holidays in your first year
• Medical, Dental, Vision, Life, and Disability Insurance
• 401(k) and Employee Stock Ownership Plan (ESOP)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 1-10 employees