Lost Time WC Claims Adjuster

The Jonus Group; Pittsburgh (Allegheny County); On-site; USD 85,000 - 100,000; Full time

Job summary

The Jonus Group is seeking a Lost Time Workers' Compensation Claims Adjuster in the United States to join our growing team. The role requires strategic thinking, investigative prowess, and the ability to deliver excellent service while handling a high-volume caseload.

Responsibilities include conducting investigations, gathering information, reviewing medical bills, filing with the Industrial Commission, and coordinating with attorneys and case management.

Qualifications

• Minimum of 5 years in workers' compensation claims, with at least 3 years in Lost Time.
• Ability to work independently and manage a high-volume caseload.
• Excellent communication with insureds, injured workers, and attorneys.
• Fluent in English; Spanish language skills are a plus.

Responsibilities

• Investigate to determine coverage and liability for new claims.
• Gather information from employers and injured employees, including statements.
• Review medical bills for proper payment and refer for audit when needed.
• File required forms with the Industrial Commission and ensure compliance.
• Establish and adjust reserves for claims.
• Coordinate medical case management and ensure necessary care for injured workers.
• Collaborate with attorneys and represent the company at mediations/hearings.
• Utilize ImageRight and proprietary claims software to manage claims efficiently.

Skills

English fluency

Interpersonal skills

Problem solving

Independent work

Caseload management

Spanish a plus

Tools

ImageRight

Claims software

Job description

Lost Time Workers' Compensation Claims Adjuster

Job Summary

Seeking a highly skilled and motivated Lost Time Workers' Compensation Claims Adjuster to join a dynamic and growing team. This role requires a strategic mindset, strong investigative skills, and the ability to work independently while delivering exceptional customer service.

Compensation Package

• Salary: $85,000 - $100,000 annually, plus quarterly performance-based bonuses (up to $1,500 per quarter).

Responsibilities

• Conduct thorough investigations to determine coverage and liability for new claims.
• Communicate with employers and injured employees to gather necessary information, including recorded statements.
• Review medical bills to ensure proper payment and refer bills for audit when necessary.
• File required forms with the Industrial Commission and maintain compliance with workers' compensation laws.
• Establish and adjust appropriate reserves for claims.
• Coordinate medical case management services and ensure injured employees receive necessary care.
• Collaborate with attorneys on legal matters and represent the company at mediations and hearings.
• Utilize proprietary claims software and ImageRight to manage claims efficiently.

Qualifications/Requirements

• Minimum of 5 years of experience in Workers' Compensation claims handling, with at least 3 years specializing in Lost Time claims.
• Strong problem-solving skills and the ability to work independently.
• Proven ability to prioritize tasks and manage a high-volume caseload effectively.
• Excellent interpersonal and communication skills, with the ability to build and maintain relationships with insureds, injured workers, and attorneys.
• Fluent in English; Spanish language skills are a plus.
• Familiarity with jurisdictions in NC, SC, GA, KY, and TN is highly preferred. Experience in PA, MD, and DE is also advantageous.
• Proficiency in using claims management software and a strong understanding of workers' compensation laws and regulations.