Mid-Atlantic Workers Compensation Claims Adjuster

Seeking a skilled and detail-orientedWorkers Compensation Claims Adjusterfor a remote position. This role focuses on analyzing investigating and resolving workers compensation claims while providing exceptional service to policyholders claimants and business partners. Candidates should have a strong understanding of workers compensation laws specific to the Mid-Atlantic region and demonstrate a commitment to accuracy efficiency and integrity. This position offers the flexibility to work from home and contribute to effective claims solutions.

• Investigate and evaluate workers compensation claims to determine coverage compensability liability and benefits owed.
• Conduct detailed reviews of medical records employment records and other documentation to assess claims.
• Interpret and apply Mid-Atlantic workers compensation laws statutes and regulations.
• Communicate effectively with injured employees employers medical providers attorneys and internal stakeholders to ensure the timely resolution of claims.
• Authorize treatment and payments within designated authority levels while ensuring compliance with company policies and applicable state laws.
• Handle claim settlements reviews and negotiations in a fair and ethical manner.
• Prepare and deliver reports documenting claim activity reserve adequacy and resolution strategies.
• Evaluate ongoing medical treatment plans and facilitate return-to-work options when feasible.
• Collaborate with legal teams as needed to support litigation and dispute resolution efforts.
• Maintain accurate and up-to-date claim records in accordance with organizational policies and compliance requirements.

• High school diploma or equivalent required; Bachelors degree in a related field preferred.
• Minimum of 3-5 years of experience as a workers compensation claims adjuster or related role.

• Must hold a valid claims adjuster license in at least one Mid-Atlantic state (e.g. VA MD DE PA NJ) and be eligible for any additional licensing as required.
• Relevant industry certifications (e.g. AIC CPCU) are a plus.

• In-depth knowledge of Mid-Atlantic workers compensation regulations industry standards and best practices.
• Strong analytical and problem-solving skills with the ability to make sound decisions.
• Clear communication and interpersonal skills with a focus on empathy and diplomacy.
• Proficiency in using claims management software as well as Microsoft Office Suite (Word Excel Outlook).
• Strong organizational and time management skills with the ability to manage a high-volume caseload.

• Proven ability to work independently within a remote environment.
• Strong ethical conduct and ability to handle sensitive information with integrity.

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