Lost Time WC Claims Adjuster

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

Job summary

Jonus Group is seeking a Lost Time Workers' Compensation Claims Adjuster in the United States to join a growing team. The role demands a strategic mindset, investigative skills, and the ability to work independently while delivering exceptional service.

With 5+ years in workers' compensation claims, you will handle investigations, communicate with employers and injured workers, review medical bills, file required forms, and coordinate medical case management. Proficiency in ImageRight is a plus.

Qualifications

• Minimum of 5 years of experience in Workers' Compensation claims handling, with at least 3 years in Lost Time claims.
• Strong problem-solving skills and ability to work independently.
• Proven ability to prioritize tasks and manage a high-volume caseload.

Responsibilities

• Conduct thorough investigations to determine coverage and liability for new claims.
• Communicate with employers and injured employees to gather information, including 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.

Skills

Investigation

Communication

Claims software

Industry knowledge

Bilingual English/Spanish

Tools

ImageRight

Proprietary 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.

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