Senior Claims Adjuster, Workers Compensation in United States at Jobgether
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Job Description
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Senior Claims Adjuster, Workers Compensation in United States.
This role plays a critical part in delivering high-quality claims management and ensuring an excellent customer experience across complex workers’ compensation cases. You will handle end-to-end claim lifecycles, including high-exposure and high-value cases, while ensuring compliance with statutory and regulatory requirements. The position requires strong analytical judgment to evaluate liability, set reserves, and drive timely and accurate compensability decisions. You will collaborate closely with internal teams, external partners, legal counsel, and insured clients to achieve optimal claim outcomes. The environment is fast-paced and detail-driven, requiring both technical claims expertise and strong communication skills. This role also emphasizes proactive claims resolution, cost control, and continuous improvement in claims processes and customer service delivery.
- Manage end-to-end workers’ compensation claims from setup through closure, including complex and high-exposure cases.
- Conduct timely investigations, including 3-point contact and ongoing fact gathering as cases evolve.
- Determine compensability, set and adjust reserves, and ensure alignment with company guidelines and statutory requirements.
- Manage medical, indemnity, and litigation processes, including coordination with defense counsel and legal cost control.
- Identify early resolution opportunities and negotiate settlements to achieve favorable claim outcomes.
- Ensure compliance with all applicable regulatory, statutory, and jurisdictional requirements.
- Serve as a key point of contact for agents, insureds, and internal stakeholders, providing claim updates and guidance.
- Support customer service excellence by improving claims processes, workflows, and operational standards.
- 5+ years of experience in workers’ compensation claims adjusting, preferably within an insurance carrier environment.
- Strong expertise handling complex, high-dollar, and high-exposure claims across multiple jurisdictions.
- Active or eligible licensing for workers’ compensation claims handling in relevant U.S. states.
- Strong understanding of claims adjudication, medical management, litigation processes, and regulatory requirements.
- Experience with jurisdictions such as Maryland, New Jersey, and Pennsylvania preferred.
- Excellent communication skills with the ability to clearly explain complex claim decisions.
- Strong problem-solving and analytical skills with sound judgment under minimal supervision.
- Ability to manage competing priorities and maintain accuracy in a high-volume environment.
- Experience mentoring or supporting junior adjusters is a plus.
- Competitive base salary range ($85,000 – $110,000 USD).
- Equity participation (“a piece of the company”).
- Comprehensive health, dental, and vision insurance coverage.
- Generous paid time off and parental leave benefits.
- 401(k) retirement plan with employer contribution.
- Remote-first work environment within the United States.
- Disability, life insurance, and additional financial protection benefits.
- Professional growth in a mission-driven insurance technology environment.