Workers Compensation Senior Adjuster
About The Position
The Workers Compensation Senior Adjuster analyzes claims, sets financial reserves, approves payments, and coordinates with medical providers, legal representatives, and internal departments. The role supports case management, benefit calculations, and 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 with budget planning and reporting, oversees complex claims, provides guidance to adjusters, and determines compensability based on claim and medical documentation. The role also reviews reserves and reimbursement amounts, calculates benefits, approves medical-provider payments and third-party invoices, coordinates case assignments and oversight, supports OSHA reporting and recordkeeping, and may testify in litigation matters within the Choctaw Nation court system.
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 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 on their resolution and handling.
- Analyze employer reports, medical documentation, and associate interviews to determine compensability.
- Review documentation to set reserves, determine reimbursement amounts for providers and team members, and calculate benefits such as injury leave and mileage for accounting submission.
- 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.
- Liaise 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.
Benefits
- Free gym membership.
- Free access to employee health clinic.
- Free lunch for casino and resort associates.
- Earned-wage access once per week for hourly associates.
- Pet insurance.
- Paid vacation and sick time.
- Medical, dental, and vision coverage.
- 401(k) with company match.
- College tuition reimbursement.
- Short-term disability, long-term disability, and family leave.
- Employee assistance program.
- Employee prescription program.
- Company-paid life insurance.
- Teladoc.
- On-site dental clinics.
- On-site mammogram services.
- Free diabetes and hypertension monitoring benefit.
- Concierge benefits program.
- Wellness program with savings on health insurance costs.
- Maternity care program. Benefits depend on employment classification.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
