Job Description
Job Title : Workers' Compensation Claims Adjuster
Job Summary The Workers' Compensation Claims Adjuster is responsible for evaluating, investigating, and managing workers' compensation claims from initiation to resolution. This role ensures compliance with state and federal workers' compensation laws, determines claim compensability, processes benefit payments, and handles complex litigated claims such as continuous trauma, AOE/COE (Arising Out of Employment/Course of Employment), stress claims, and safety claims.
Key Responsibilities - Review and evaluate workers' compensation claims to determine compensability based on medical reports, investigative findings, and applicable regulations.
- Authorize and process benefit payments including Temporary Total Disability (TTD), Permanent Disability (PD), and Life Pension (LP).
- Conduct investigations by gathering statements, reviewing accident reports, and analyzing medical records to assess claim validity.
- Communicate with injured employees, explaining their benefits, rights, and legal options under Workers' Compensation Laws.
- Handle litigated claims, preparing documentation for subrogation, settlement negotiations, and hearings, and coordinating with attorneys, medical professionals, and insurance representatives.
- Collaborate with physicians, employers, and legal professionals to ensure appropriate medical treatment and return-to-work planning.
- Maintain accurate and detailed claim files, documenting key developments, correspondence, and payment activity.
Required Qualifications & Skills - Minimum of three (3) years of experience in adjusting workers' compensation claims within the last five (5) years.
- At least one (1) year of experience handling complex litigated claims, including continuous trauma, AOE/COE, stress claims, and safety claims.
- Strong knowledge of workers' compensation laws, medical terminology, and claims processing procedures.
- Ability to analyze medical reports, communicate effectively with medical professionals, and determine appropriate claim actions.
- Experience coordinating with attorneys and preparing documentation for litigation and settlement negotiations.
- Excellent investigative, problem-solving, and negotiation skills.
- Proficiency in claims management systems and Microsoft Office Suite.
Preferred Qualifications - Certification as a Workers’ Compensation Claims Adjuster (WCCA) or equivalent.
- Experience working in self-insured or third-party administration (TPA) environments.
- Knowledge of subrogation processes and litigation case management.
This role requires strong analytical abilities, attention to detail, and the ability to handle sensitive claims with professionalism and compliance. The ideal candidate will be experienced in managing workers' compensation cases efficiently while ensuring fair and lawful claim resolutions.
Subject to a background check upon selection and a hybrid work schedule after two weeks in the office for acclamation (2 days a week in the office).
Talantage, LLC is committed to presenting candidates that contribute to an organizations culture of inclusivity and its commitment to diversity in the workplace are demonstrated through our recruitment practices. We are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, gender, gender identity, sexual orientation, marital status, national origin, citizenship status, disability, age, or veteran status. Our equal opportunity employment efforts comply with all applicable U.S. state and federal laws governing non-discrimination in employment.
Job Tags
Permanent employment, Temporary work, Work at office, 2 days per week,