Job Description
Job DescriptionJob Title: Claims AdjusterLocation: USAHire Type: ContingentPay Range: $35.00/hourWork Type: Full-timeWork Model: OnsiteWork Schedule: Monday – Friday, 8:30am – 4:30pm Recruiter Contact: Sean Craft, sean@marykraft.comNature & Scope:Positional OverviewWe are seeking an experienced Workers’ Compensation Claims Adjuster to manage mid- to high-level lost-time workers’ compensation claims. This role is responsible for determining compensability and benefits due, managing reserves, coordinating return-to-work efforts, identifying subrogation opportunities, and negotiating settlements. The ideal candidate will have proven experience handling Pennsylvania and New Jersey lost-time claims and will ensure claims are adjudicated in compliance with company standards, state regulations, and industry best practices.Role & Responsibility:Tasks That Will Lead to Your Success
- Manage end-to-end handling of mid- and higher-level workers’ compensation lost-time claims, including investigation, compensability determination, and ongoing claim administration.
- Develop and execute claim-specific action plans to drive timely and appropriate resolutions.
- Monitor and maintain reserve adequacy throughout the life of the claim.
- Approve and issue indemnity and medical payments in accordance with statutory and contractual requirements.
- Prepare and submit required documentation and filings with applicable state agencies.
- Ensure claim files are thoroughly documented and claims coding is accurate.
- Apply in-depth knowledge of Pennsylvania and New Jersey workers’ compensation statutes, regulations, and case law.
- Prepare and file state-specific forms, including PA LIBC forms and NJ WC filings.
- Manage EDI submissions and resolve filing errors as needed.
- Accurately calculate Average Weekly Wage (AWW) and Temporary Total Disability (TTD) benefits.
- Apply jurisdiction-specific rules, including PA’s 7-day waiting period and NJ’s 7-day retroactive provisions.
- Coordinate medical treatment plans, utilization review, and compliance with state medical fee schedules.
- Apply NJ authorized provider rules and PA panel provider requirements.
- Manage litigated claims by working closely with defense counsel, attending hearings, and preparing testimony as needed.
- Demonstrate knowledge of PA’s Supersedeas process and NJ’s informal and formal hearing procedures.
- Handle complex lifetime medical and defined-period medical claims, including physician and state filings.
- Collaborate with employers to develop modified duty programs and facilitate early return-to-work.
- Identify and manage subrogation opportunities.
- Negotiate lump-sum settlements, including Compromise & Release (PA) and Section 32 agreements (NJ).
- Prepare settlement evaluations and manage Medicare compliance requirements when applicable.
- Maintain regular communication with injured workers, employers, medical providers, and attorneys.
- Provide superior customer service and professional phone etiquette.
- Clearly and timely document all claim activities and correspondence.
Skills & ExperienceQualifications That Will Help You Thrive
- Minimum five (5) years of direct experience managing lost-time workers’ compensation claims in both Pennsylvania and New Jersey required.
- Experience handling additional jurisdictions is a plus.
- Workers’ compensation adjuster licenses preferred but not required.
- Strong technical expertise in lost-time indemnity claim management.
- Excellent analytical, organizational, and negotiation skills.
- Strong written and verbal communication abilities.
- Ability to manage a high-volume caseload independently in a remote environment.
- Proficient in claims management systems, EDI processing, and Microsoft Office.