Senior Claims Adjuster, Workers Compensation

Accountabilities: Independently manage workers’ compensation claims throughout the entire lifecycle, from initial setup and investigation through closure.

Handle complex, high-dollar, and high-exposure claims, continuously evaluating changing facts and identifying opportunities to mitigate financial and operational exposure.

Conduct timely three-point contact investigations and make accurate compensability decisions in accordance with applicable statutory requirements.

Establish and adjust reserves promptly and accurately, ensuring reserves reflect current claim facts, exposure, and established best practices.

Administer statutory medical and indemnity benefits throughout the life of each claim while maintaining compliance with applicable laws, regulations, and jurisdictional requirements.

Manage litigation activity in partnership with defense counsel, including oversight of legal strategy, fees, costs, and opportunities for early resolution.

Evaluate settlement opportunities, negotiate resolutions, and make sound claim decisions designed to achieve favorable outcomes.

Present complex claims, exposure assessments, and recommendations to senior management and internal or external stakeholders.

Serve as a trusted point of contact for agents, insureds, and business partners, providing claim guidance, status updates, coverage information, and loss-run support as needed.

Deliver a high-quality customer experience by setting clear expectations, communicating effectively, and advocating for timely and effective claims resolution.

Identify gaps and improvement opportunities across claims operations, service standards, handling procedures, protocols, and workflows.

Mentor junior adjusters and contribute to a culture of accountability, collaboration, continuous improvement, and technical excellence.

Requirements

High school diploma or equivalent required; a bachelor’s degree or equivalent experience with some college coursework is preferred.

At least 5 years of workers’ compensation claims adjusting experience required, preferably within a carrier environment.

Experience handling workers’ compensation claims in states such as Florida, Georgia, North Carolina, South Carolina, and/or Tennessee is preferred.

Active claims licensing in applicable states is required.

Demonstrated ability to evaluate and manage high-dollar, high-exposure, and complex workers’ compensation claims.

Advanced knowledge of jurisdictional regulatory and statutory requirements, as well as CMS/MSA requirements.

Strong experience in claim adjudication, medical management, litigation management, reserving, compensability analysis, and settlement negotiations.

Ability to analyze multiple sources of information, identify key risks, and take appropriate action across complex claims.

Strong judgment and problem-solving skills, with the ability to independently navigate difficult situations and determine effective solutions.

Excellent written and verbal communication skills, including the ability to explain complex claims information clearly to different audiences.

Demonstrated ability to manage conflict, negotiate effectively, and pursue outcomes that balance customer needs with business objectives.

Strong organizational skills and awareness of how individual responsibilities affect broader team performance and deliverables.

Ability and willingness to mentor and support the development of junior claims professionals.

Familiarity with G-Suite and collaboration platforms such as Slack is preferred.

Benefits

Salary: $85,000–$110,000 USD base compensation range.

Competitive cash compensation with potential for discretionary bonuses based on company performance and eligibility.

Comprehensive health insurance plans.

Generous paid time off.

401(k) retirement plan with employer matching.

Generous parental and caregiver leave.

Remote work opportunity for team members living and working in the United States, excluding U.S. territories.

Flexible, technology-enabled work environment supported by reliable high-speed internet.

A collaborative culture focused on customer impact, continuous improvement, accountability, and innovation.

Opportunities to contribute to process improvements and develop professionally within a growing insurance technology environment.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

#LI-CL1