Sr. Workers Compensation Adjuster

Questpro; Oteneagen Township (MN); On-site; USD 70,000 - 105,000; Full time

Job summary

Questpro in Minnesota is seeking a Claims Manager to oversee complex workers’ compensation caseloads, ensuring compliant, timely decisions and effective settlements. You will coordinate with providers, attorneys, and internal teams to optimize outcomes.

The role requires strong communication, analytical and negotiation skills, plus the ability to mentor others and manage multi-jurisdictional nuances. Local licensing and travel may be required.

Qualifications

• High School diploma or equivalent required, College degree preferred.
• 3+ years of workers’ compensation claims handling experience preferred.
• Minnesota Adjusters License required.
• Experience in client-facing roles such as account management, claims consulting, or relationship management preferred.
• Prior experience mentoring or training others is a strong plus.
• 1–2 years of Workers’ Compensation lost time claims adjusting experience or equivalent experience.

Responsibilities

• Manage caseload including complex or high-exposure workers’ compensation claims through investigation, evaluation, negotiation, and resolution.
• Determine compensability, calculate benefits, and authorize medical and indemnity payments in accordance with state laws and company policy.
• Coordinate treatment plans, return-to-work programs, and settlement strategies with medical providers, attorneys, TBG members, and vendors.
• Maintain detailed documentation in the claims management system and ensure timely reporting and compliance with regulatory requirements.
• Participate in mediations, settlement conferences, and hearings as needed, often in collaboration with outside counsel.
• Collaborate with internal medical, legal, and risk management resources to ensure optimal claim outcomes.
• Identify opportunities for early intervention, cost containment, and fraud prevention.
• Educate members on claims trends, loss drivers, and best practices for injury prevention.
• Collaborate cross-functionally with underwriting, account management, and loss control to deliver coordinated client solutions.

Skills

Communication skills

Analytical ability

Negotiation

Detail oriented

Organizational skills

Education

High School diploma

College degree

Tools

Microsoft Office

Job description

Claims Management

• Manage of caseload including complex or high-exposure workers’ compensation claims through investigation, evaluation, negotiation, and resolution.
• Determine compensability, calculate benefits, and authorize medical and indemnity payments in accordance with state laws and company policy.
• Coordinate treatment plans, return-to-work programs, and settlement strategies with medical providers, attorneys, TBG members, and vendors.
• Maintain detailed documentation in the claims management system and ensure timely reporting and compliance with regulatory requirements.
• Participate in mediations, settlement conferences, and hearings as needed, often in collaboration with outside counsel.
• Collaborate with internal medical, legal, and risk management resources to ensure optimal claim outcomes.
• Identify opportunities for early intervention, cost containment, and fraud prevention.
• Educate members on claims trends, loss drivers, and best practices for injury prevention.
• Collaborate cross-functionally with underwriting, account management, and loss control to deliver coordinated client solutions.

Compliance and Best Practices

• Ensure full compliance with applicable federal, state, and local workers’ compensation laws and regulations. Adhere to internal policies, procedures, and service standards.
• Stay informed on industry changes, case law, medical guidelines, and legislative updates.
• Maintain required adjuster licenses and participate in continuing education and professional development.
• Contribute to the development and refinement of claims handling procedures and client service protocols.
• Promote ethical conduct and high-quality claim management at all times.

QUALIFICATIONS/SKILLS:

• High School diploma or equivalent required, College degree preferred.
• 3+ years of workers’ compensation claims handling experience preferred.
• Must have a Minnesota Adjusters License.
• Experience in client-facing roles such as account management, claims consulting, or relationship management preferred.
• Prior experience mentoring or training others is a strong plus.
• Multi-jurisdictional claims experience desirable.Minimum of one (1) to two (2) years Workers’ Compensation lost time claims adjusting experience, or equivalent experience.
• Ability to coordinate and prioritize daily workflow of a moderate technical complexity.
• Must be detail oriented and a self-starter with strong organizational abilities.
• Excellent written and oral communication skills.
• Proficient using Microsoft Office programs such as Word, Excel, Outlook, etc.
• Ability to work with initiative in a mostly independent environment.
• Working knowledge of claim procedures, policies, terminology, etc.
• Working understanding of differences in techniques, medical care available and vocational possibilities within geographic areas of the state.
• Demonstrate problem-solving and analytical ability.
• Spanish bilingual desirable or other languages.
• Ability to travel as necessary.
• Ability to negotiate, build consensus and resolve conflict.
• Ability / willingness to acquire a valid MN State adjusting license.
• Sit, stand, walk/ambulatory; ability to lift 10 pounds.