Workers’ Compensation Medical Only Claims Adjuster (Remote)

We’re seeking a Workers’ Compensation Medical Only Claims Adjuster who brings strong technical expertise, sound judgment, and a proactive approach to managing indemnity and medical-only claims.

This role manages Workers’ Compensation claims from intake through resolution and may support medical-only claim types depending on the assigned client program. The adjuster investigates, evaluates, and manages claims in accordance with company guidelines, client expectations, and jurisdictional requirements.

Key Responsibilities

Claim Ownership & Adjudication

• Manage Workers’ Compensation claims from intake through closure
• Determine compensability and benefit eligibility
• Establish and adjust reserves based on claim exposure

Investigation & Case Management

• Conduct investigations, including interviews and documentation review
• Develop and execute claim strategies
• Identify opportunities for early resolution

Medical & Indemnity Management

• Monitor treatment plans and coordinate return-to-work efforts
• Administer indemnity benefits in compliance with jurisdictional requirements

Litigation Management

• Coordinate with defense counsel on litigated claims
• Support hearings, mediations, and settlements

Client Communication & Compliance

• Provide timely updates to clients and stakeholders
• Ensure compliance with all state regulations and internal standards

Skills, Knowledge & Expertise

• Strong knowledge of Workers’ Compensation laws, benefit structures, and claims processes
• Experience managing indemnity payments and return-to-work programs
• Ability to handle multiple claims in a fast-paced environment
• Strong investigative, analytical, and decision-making skills
• Effective negotiation and problem-solving abilities
• Excellent written and verbal communication skills
• Proficiency with claims management systems and related technology
• Active adjuster license(s) or ability to obtain as required
• Active FL license needed

Preferred Qualifications

• Multi-state claims handling experience
• Experience with EDI reporting and jurisdictional compliance requirements
• Familiarity with nurse case management and medical cost containment strategies

Benefits

• 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