Job Description

Job Description

Job Description

Job Profile

Job Title: Claims Adjuster

Location: Remote

Hire Type: Contingent 3 months

Pay Range: $45 - $50

Work Model: Remote

Work Shift: Monday-Friday 8 am – 4 pm

Recruiter Contact: Sean Craft I sean@marykraft.com I 443-345-3305

Nature & Scope:

Positional Overview

We are seeking a knowledgeable and experienced Workers’ Compensation Claims Adjuster to join our team on a contract basis. The ideal candidate will have extensive experience handling claims in Southeast state jurisdictions including Alabama (AL), Georgia (GA), Florida (FL), North Carolina (NC), South Carolina (SC), and Tennessee (TN) . This role involves evaluating and managing mid-to-complex level indemnity claims to determine compensability, administer benefits, and ensure compliance with company standards and regional regulations.

Role & Responsibility:

Tasks That Will Lead to Your Success

• Analyze and manage indemnity workers' compensation claims in Southeast state jurisdictions, determining compensability and benefit eligibility.
• Develop and implement claim-specific action plans to support efficient resolution and return-to-work goals.
• Monitor and adjust reserves to ensure financial accuracy throughout the claim lifecycle.
• Process claims approvals, payments, and documentation in line with client contracts and regulatory requirements.
• File necessary documentation with state agencies in accordance with jurisdictional guidelines.
• Handle subrogation efforts and negotiate claim settlements when applicable.
• Communicate with claimants and clients professionally and promptly, keeping all stakeholders informed.
• Ensure claims files are thoroughly documented and correctly coded.
• May manage lifetime or defined-period medical claims , including physician filings and treatment approvals aligned with utilization review decisions.

Skills & Experience

Qualifications That Will Help You Thrive

• High School diploma or GED required.
• Bachelor’s degree from an accredited institution preferred.
• Minimum 5 years of relevant workers' compensation claims experience.
• Required experience managing claims in at least one or more Southeast jurisdictions: AL, GA, FL, NC, SC, TN.
• Strong understanding of state-specific WC regulations , medical management practices, and disability duration standards.
• Working knowledge of subrogation, offsets, and Social Security/Medicare-related procedures.
• Proficient with Microsoft Office and claims management software.
• Strong analytical, decision-making, and problem-solving abilities.
• Excellent verbal and written communication skills.
• Effective negotiation and interpersonal skills.
• Ability to work independently and in a team-oriented environment.
• Strong organizational and time-management capabilities.
• Demonstrated ability to meet or exceed service level expectations.

Job Tags

Similar Jobs