Workers' Compensation Claims Adjuster

Enlyte • Egg Harbor Township, NJ

1d • Remote

About The Position

This is a full-time remote position that can be located anywhere in the U.S. Must be able to work EST or CT time zone. The role involves completing internal training in adjusting medical-only workers' compensation claims, evaluating claimant eligibility, and communicating with physicians, employers, and injured workers. The adjuster will confirm coverage, establish compensability through investigation and evaluation, and ensure timely payment or denial of benefits. Responsibilities also include identifying potential for third-party recovery, investigating suspect claims, establishing and maintaining claim reserve levels, managing claim diaries for timely resolution, and closing files efficiently. The role requires overseeing and coordinating medical treatment, providing information to treating physicians and nurse case managers, and working with employers to facilitate return to work. Additionally, the adjuster will complete payment authorization requests (PARs) or claims analysis reports (CARs) when applicable, communicate effectively with internal and external parties, and provide a high degree of customer service, including face-to-face interactions during claim reviews and meetings. Other duties as required will also be performed.

Requirements

• High School Diploma (required)
• Proficient with MS Excel and Word
• Computer experience with related claims software
• Excellent verbal and written communication skills
• Proven interpersonal skills with all levels of personnel
• Superior organizational skills
• Customer-focused orientation
• Teamwork and promotes cooperation and commitment within team
• Time management and ability to control time to accomplish goals
• Hard working, diligent, reliable, and has initiative

Nice To Haves

• Associate's degree preferred, OR one or more years of insurance, medical/health, or legal-related work experience
• 1-2 years of experience handling workers' compensation claims (preferred)
• Knowledge of Workers' Compensation legal principles and related claims handling practices
• Strong analytical skills
• Understanding of medical terminology and medical/injury treatments

Responsibilities

• Complete internal training in adjusting medical only workers' compensation claims
• Evaluate claimant eligibility and communicate with attending physician, employer, and injured worker
• Confirm coverage and applicable insurance policy or coverage document and statutory requirements
• Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws
• Ensure timely payment or denial of benefits in accordance with jurisdictional requirements
• Identify potential for third party recovery, including subrogation, and pursue reimbursement process
• Investigate potentially suspect claims, possibly with aid of a field investigator assignment
• Establish claim reserve levels by estimating potential exposure of each assigned claim and maintain/adjust reserves over claim life
• Manage diary in accordance with Best Practices and complete tasks to ensure timely case resolution
• Close all files in a timely and complete manner, maintaining closing ratio as directed by management
• Oversee and coordinate medical treatment for injured employees and provide information to treating physicians and/or nurse case managers
• Work directly with employers to facilitate return to work on transitional or full-time basis
• Complete PARs (payment authorization request) or CARs (claims analysis report) when applicable
• Communicate effectively, verbally and in writing, with internal and external parties on claims and account-related issues
• Provide high degree of customer service to clients, including face-to-face interactions during claim reviews, meetings, and similar account-specific sessions
• Perform other duties as required

Benefits

• Full and comprehensive benefits program
• 24 days of paid vacation/holidays in your first year plus sick days
• Home office equipment including laptop, 2 desktop monitors, mouse, headphones, ect.
• Employee Assistance and Referral Program
• Medical
• Dental
• Vision
• Health Savings Accounts / Flexible Spending Accounts
• Life and AD&D Insurance
• 401(k)
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED