Job Description

Mid-Atlantic Workers Compensation Claims Adjuster - Remote

Job Summary

Seeking a skilled and detail-oriented Workers Compensation Claims Adjuster for 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.

Responsibilities

• 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.

Qualifications/Requirements

Education & Experience

• High school diploma or equivalent required; Bachelor’s degree in a related field preferred.


• Minimum of 3-5 years of experience as a workers' compensation claims adjuster or related role.

Licensing & Certification

• 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.

Knowledge & Skills

• 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.

Core Competencies

• Proven ability to work independently within a remote environment.


• Strong ethical conduct and ability to handle sensitive information with integrity.

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