Sr. Workers Compensation Claims Adjuster

Claims Resolution Corporation Inc.; Galloway Township (NJ); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Claims Resolution Corporation Inc. seeks a senior workers’ compensation adjuster to independently manage a caseload with medical, indemnity, and excess reports.

The role involves investigating, evaluating, and resolving claims across New Jersey and Pennsylvania while coordinating with medical providers and legal counsel. The position emphasizes training peers, mentoring, and client advocacy, with a hybrid or in-person arrangement and potential remote consideration for NJ, PA, or DE residents.

Qualifications

• 7+ years of handling Medical Only/Workers’ Compensation claims.
• Active or eligible to obtain required adjuster licenses.
• Strong attention to detail and investigative mindset.
• Excellent written, verbal, and interpersonal communication skills.
• Public entity experience strongly preferred.
• Strong public speaking and presentation skills are essential.

Responsibilities

• Independently manage a caseload of workers' compensation claims.
• Investigate, evaluate, and resolve lost time claims in NJ/PA.
• Establish claim reserve levels and monitor changes.
• Report to excess carriers per policy thresholds.
• Coordinate with medical providers and legal counsel.
• Participate in client claim reviews as needed.
• Make timely compensability determinations.
• Document action plans, reserves, and SIR involvement.
• Coordinate medical treatment and review medical bills.
• Prepare comprehensive reports for clients and leadership.
• Negotiate settlements within authority and track payments.

Skills

7+ years experience

Detail oriented

Investigative mindset

Excellent communication

Public entity experience

Strong presentation skills

Tools

Microsoft Office

Claims software

Job description

Position Summary

This senior-level position is responsible for independently managing a caseload of medical treatment claims involving lost time, multiple body part injuries, and litigation in New Jersey and /or Pennsylvania. The adjuster manages the investigation, evaluation, and resolution of workers’ compensation claims in compliance with legal statutes, policy terms, and client-specific instructions. The adjuster coordinates medical care, negotiates settlements, and works closely with claimants, clients, attorneys, and medical professionals to achieve timely, cost-effective outcomes. This role involves training and mentoring fellow adjusters and peers to enhance their technical skills and support their career advancement. Additionally, it serves as a client advocate by addressing claim concerns and delivering consistent, high-quality service. This position is primarily hybrid or in-person; however, a remote work option may be considered for candidates residing in NJ, PA, or DE.

Duties/Responsibilities

• Independently manage a caseload of workers' compensation claims involving medical, indemnity and excess reportable claims.
• Investigate, evaluate, and resolve lost time claims in compliance with NJ and/or PA with applicable jurisdictional workers' compensation laws.
• Establish claim reserve levels by estimating the cost of each assigned claim; monitor reserves and update amounts as claim conditions evolve.
• Report to excess carriers in accordance with policy thresholds and contractual obligations.
• Coordinate with medical providers, nurse case managers, and legal counsel to ensure appropriate treatment and litigation strategy.
• Participating in client claim reviews, according to the needs of the client.
• Make timely compensability determinations in compliance with applicable jurisdictional laws.

• Document action plans, reserve changes, insurance coverage info, and SIR involvement.
• Identify potential fraud and alert management accordingly.
• Coordinate medical treatment, pre-authorizations, and review medical bills.
• Calculate and issue indemnity benefits, including death/dependency benefits in a timely and accurate manner.

• Prepare comprehensive reports and updates for clients and internal leadership.
• Communicate effectively with injured workers, employers, attorneys, and internal stakeholders.
• Facilitate round table discussions with peers regarding challenging claims.
• Maintain detailed and timely documentation in claims management systems.

• Negotiate claim settlements within authority and accurately process and track award payments.
• Maintain consistent and professional communication with claimants, providers, attorneys, employers, and clients.

Qualifications & Competencies

• 7+ years of handling Medical Only/Workers’ Compensation claims.
• Public entity experience strongly preferred.
• Active or eligible to obtain required adjuster licenses.
• Strong attention to detail and investigative mindset.
• Excellent written, verbal, and interpersonal communication skills.
• Strong public speaking and presentation skills are essential.
• Proficient in Microsoft Office, web-based systems, and claims software.

Physical Requirements

• Prolonged periods of sitting at a desk and working on a computer.