Workers Compensation Senior Adjuster

Choctaw Nation of Oklahoma • Durant, OK

3d

About The Position

The Workers Compensation Senior Adjuster analyzes claim data, sets financial reserves, approves payments, and coordinates with medical providers, legal representatives, and internal departments. The role supports case management, benefit calculations, and continuous process improvement to ensure effective and compliant claims administration. The position reports to the Workers Compensation Manager and works Monday through Friday, 8:00 a.m. to 4:30 p.m.

The Senior Adjuster assists the Manager with budget planning and reporting to department leadership, oversees complex claims, and provides expert guidance to adjusters. The role reviews employer reports, medical documentation, and associate interviews to determine compensability; sets reserves; determines reimbursements; and calculates benefits such as injury leave and mileage for submission to accounting. It also involves testifying in litigation matters within the Choctaw Nation court system, reviewing the Workers’ Compensation fee schedule, approving medical-provider payments and third-party invoices, and coordinating reimbursement processing.

The Senior Adjuster assigns complex claims to case managers and ensures timely updates and ongoing oversight. The role serves as a liaison between CNOSH and Workers' Compensation for accurate and timely OSHA reporting and recordkeeping, and coordinates case management with CNHSA, CNOSH, and external medical providers. Other duties may be assigned.

Requirements

• Bachelor’s degree in General Studies or an equivalent combination of education and experience.
• Workers’ Compensation Adjuster License, or ability to attain the license within 90 days of hire.
• Ability to determine compensability and the need for subrogation.
• Excellent communication skills.
• Knowledge of Workers’ Compensation systems.
• Knowledge of statutes to analyze situations accurately.
• Knowledge of medical terminology.
• Knowledge of Occupational Safety & Health recordkeeping requirements.
• Five years of experience adjusting claims and reserving claims.

Nice To Haves

• Bilingual proficiency.

Responsibilities

• Assist the Manager with budget planning and reporting to department leadership.
• Oversee complex claims and provide expert guidance to adjusters in resolving and handling cases.
• Analyze employer reports, medical documentation, and associate interviews to determine claim compensability.
• Review documentation and set appropriate financial reserves.
• Determine reimbursement amounts for providers and team members, and calculate benefits such as injury leave and mileage for submission to accounting.
• Testify in litigation matters within the Choctaw Nation court system.
• Review the Workers’ Compensation fee schedule, approve medical-provider payments and third-party invoices, and coordinate reimbursement processing.
• Assign complex claims to case managers and ensure timely updates and ongoing case oversight.
• Serve as the liaison between CNOSH and Workers' Compensation to ensure accurate and timely OSHA reporting and recordkeeping compliance.
• Coordinate internal case management activities involving CNHSA, CNOSH, and external medical providers to ensure comprehensive care and compliance.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior