Sr. Workers' Compensation Adjuster

Commonwealth of Massachusetts; Boston (MA); Hybrid; USD 77,000 - 112,000; Full time

Benefits offered by this job

Hybrid work schedule

Job summary

Commonwealth of Massachusetts is seeking a Compliance Officer III within the Human Resources Division. The role is confidential, with responsibilities spanning claim analysis, medical bill processing, and litigation preparation. A strong knowledge of M.G.L.

Chapter 152 and prior investigative experience are essential. The position offers a full-time schedule, day shift, and potential for hybrid work. Applicants should have a four-year background in investigatory or regulatory work, with

Qualifications

• First consideration will be given to applicants who apply within the first 14 days.
• Minimum Entrance Requirements include four years of full-time investigatory or regulatory experience, with substitutions possible.
• A Bachelor's or higher degree may substitute up to two years of required experience.

Responsibilities

• Conduct initial 3-point contact and maintain ongoing communication with agency contacts throughout the life of the claim.
• Recognize potential Third Party/Subrogation cases.
• Maintain accurate records and payments.
• Process medical bills at DIA rates.
• Manage a caseload of lost time and medical-only claims under M.G.L. Chapter 152.
• Prepare cases for litigation when necessary.
• Calculate indemnity rates, travel reimbursements, end-of-compensation dates, and all other adjustments.
• Create and monitor a personal diary system.
• Conduct virtual/on-site reviews and trainings for internal and external customers.
• Work on special projects as assigned by management.

Skills

Communication

Empathy

Relationship-building

Investigative skills

Multitasking

Team player

Professionalism

Education

Bachelor's degree or higher

Job description

The Commonwealth of Massachusetts Executive Department is one of the state's largest employers with over 46,000 employees that span 11 Secretariats and 70 plus agencies. From Accountants to X-ray technicians with hundreds of titles in between, we are one employer with many career opportunities. The Commonwealth is looking for leaders, thinkers, creators, and innovators. We are a diverse workforce that reflects the diverse population that we serve.

The Human Resources Division (HRD) is an agency within the Executive Office for Administration and Finance. HRD provides support to state agencies in all matters relating to the Commonwealth's classification, compensation, benefits, recruitment, training & employee development, civil rights, collective bargaining and workers compensation administration.

About the Workers' Compensation Unit

The Human Resources Division/Workers' Compensation Unit (HRD/WC) is the legislatively authorized administrator of the Commonwealth’s self-insured workers’ compensation program. HRD/WC uses a medical management strategy to facilitate the employee’s recovery and return to work. It is the goal of HRD/WC to return injured employees to gainful employment in a timely, efficient way.

This position is a confidential position
This position requires a working knowledge of M.G.L. Chapter 152 as well as an ability to complete the following:

Responsibilities

• Conduct initial 3-point contact and maintain ongoing communication with agency contacts throughout the life of the claim.
• Recognize potential Third Party/Subrogation cases.
• Maintain accurate records and payments.
• Process medical bills at DIA rates.
• Manage a caseload of lost time and medical-only claims within the guidelines of M.G.L. Chapter 152.
• Prepare cases for litigation when necessary.
• Calculate indemnity rates, travel reimbursement, end-of-compensation dates, and all other required adjustments and reimbursements.
• Create and monitor a personal diary system.
• Conduct virtual/on-site workers’ compensation claim reviews/or training for internal and external customers.
• Work on special projects as assigned by the management team.

Preferred Qualifications

• 2-3 years of experience adjusting Workers' Compensation claims under M.G.L. Chapter 152.
• Ability to communicate in a clear, concise manner with an appropriate level of detail, empathy, and professionalism.
• Ability to build and maintain effective relationships with internal and external customers.
• Ability to investigate a claim by gathering and analyzing facts with the purpose of rendering a determination regarding claim compensability.
• Ability to work with minimal supervision and direction.
• Ability to maintain a professional demeanor when presented with challenging and difficult situations.
• Commitment to working in a team environment.
• Ability to adhere to strict timelines but also have the ability and flexibility to multitask in a fast-paced environment.

Qualifications

First consideration will be given to those applicants that apply within the first 14 days.

Minimum Entrance Requirements: Applicants must have at least (A) four years of full-time, or equivalent part-time, experience in investigatory or law enforcement work, or regulatory administration work (B) and equivalent combination of the required experience and the substitutions below.

Substitutions:

A Bachelor's or higher degree may be substituted for a maximum of the two years of the required experience.*

*Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed.

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

An Equal Opportunity / Aff… Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC)may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.

Official Title

Compliance Officer III

Job

Compliance and Certification

Agency

Human Resources Division

Schedule

Full-time

Shift

Day

Salary

76,817.52 - 111,796.10 Yearly

If you have Diversity, Aff… or need a Reasonable Accommodation, please contact Diversity Officer / ADA Coordinator : Pete Murillo - 6178789700

Bargaining Unit : 06-NAGE - Professional Admin.

Confidential : Yes

Potentially Eligible for a Hybrid Work Schedule : Yes