Workers' Comp Medical Only Adjuster

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Brenda Goff

Compensation: $49,500 - $55,000 / year

Description

Key Responsibilities

• Investigate assigned workers’ compensation claims by completing timely contact with injured workers, employers, physicians, witnesses, and other involved parties.
• Evaluate claim details, applicable statutes, case law, and medical information to determine compensability and claim value.
• Set and maintain appropriate reserves for the life of the claim using applicable tools, guidelines, and company reserving practices.
• Provide benefits and initiate required state filings in a timely and accurate manner.
• Monitor medical treatment in coordination with Nurse Case Managers when assigned.
• Review, document, and approve medical bills for payment within required timeframes.
• Authorize appropriate medical services in accordance with applicable workers’ compensation statutes and claim requirements.
• Maintain regular contact with injured employees to support claim progression and customer service.
• Coordinate light duty availability and reasonable accommodations with employers and medical providers.
• Review assigned impairment ratings for accuracy and take appropriate action, including transferring claims or initiating impairment benefits and filings when required.
• Maintain claim diaries, workflow requirements, and accurate file documentation.
• Review claims for potential red flags, compensability concerns, and escalation needs.
• Identify and pursue subrogation, contribution, indemnification, or other recovery opportunities when applicable.
• Adhere to client-specific claim handling instructions and service expectations.
• Attend client meetings as needed and maintain regular communication to support client satisfaction.
• Negotiate claim settlements when appropriate.
• Make timely notice to excess carriers when claims meet reporting criteria and provide ongoing updates as needed.
• Maintain required continuing education credits and licensing requirements.
• Report account, client, E&O, or quality concerns to appropriate management.
• Maintain a positive, team-oriented approach while delivering high-quality service to clients and claimants.
• Perform other duties as assigned by claims leadership.

Skills, knowledge & expertise

• Prior experience handling workers’ compensation claims.
• Working knowledge of workers’ compensation laws, rules, procedures, and claim handling practices.
• Familiarity with Florida Workers’ Compensation Statute and related claim requirements preferred.
• Strong understanding of medical terminology, medical procedures, and treatment documentation.
• Ability to evaluate compensability, claim exposure, reserves, and benefit entitlement.
• Strong written and verbal communication skills.
• Excellent organizational skills with the ability to manage diaries, deadlines, and workflow requirements.
• Ability to exercise discretion, independent judgment, and sound decision-making.
• Proficiency with Microsoft Office Suite, including Word, Excel, and Outlook.
• Ability to learn and effectively use claims management systems and related business software.
• Florida workers’ compensation claims handling experience.
• Experience handling medical-only workers’ compensation claims.
• Prior TPA experience.
• Experience with claim systems, medical bill review, ISO, and workers’ compensation reserving tools.
• Knowledge of subrogation, contribution, indemnification, and excess carrier reporting.
• Experience participating in client meetings or claim reviews.

Equal Employment Opportunity & Legal Notices

• Medical, dental, and vision plans to support your health and that of your family
• A 401(k) plan with employer matching
• Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
• Paid holidays
• Life insurance and short‑term and long‑term disability coverage