SeniorClaimsAdjuster(Workers'Compensation)

Analyzes coverage to confirm losses are covered under client policies.

Initiates contact within 24 hours with all relevant parties (clients, claimants, employees, medical providers).

Conducts thorough investigations, including fact-finding and recorded statements.

Develops and executes action plans to resolve claims efficiently.

Performs reserve analysis and sets/maintains appropriate reserves per client guidelines.

Reviews medical records and bills to assess injury, compensability, treatment, and accuracy.

Identifies risk factors and routes claims for specialized handling (SIU, subrogation, medical review) with approval.

Identifies, investigates, and pursues subrogation opportunities, including review of official reports.

Escalates complex claims and collaborates with leadership as needed.

Prepares required jurisdictional filings for workers’ compensation claims.

Evaluates coverage, liability, and claim responds to stakeholder inquiries.

Negotiates settlements, participates in mediation, and manages payments within authority recommends higher-value settlements.

Prepares and issues denial and settlement develops evaluation ranges and supports litigation, mediation, arbitration, and Medicare compliance.

Maintains diaries and action plans, provides timely responses and claim updates, conducts client consultations, coordinates vendor resources, manages reporting (including excess carriers), stays current on regulations, maintains licenses/CEUs, and supports training of team members.