Workers' Compensation Adjuster I

Claims Resolution Corporation Inc.; New York (NY); On-site; USD 55,000 - 75,000; Full time

Job summary

Claims Resolution Corporation Inc. seeks a Workers’ Compensation Adjuster I to handle Medical Only to lost time indemnity claims in New Jersey.

You will independently investigate, evaluate, and resolve claims, coordinate medical care, negotiate settlements, and work with claimants, clients, attorneys, and medical professionals to achieve timely outcomes. You will set reserves, identify fraud red flags, manage subrogation, and support early return-to-work efforts, while staying compliant with

Qualifications

• Associate degree or 3+ years of relevant workers’ compensation claims experience.
• Minimum 3 years of workers’ compensation claims handling experience.
• Public entity claims experience a plus.
• Strong customer service, organization, and attention to detail.
• Proficient in Microsoft Office and claims systems.
• Residents of NJ, PA, DE, TX or FL per posting.

Responsibilities

• Investigate Medical Only and lost time indemnity claims from routine to light complexity with minimal supervision.
• Determine compensability in accordance with jurisdictional requirements.
• Develop and maintain a resolution plan covering medical, indemnity, litigation, and settlement strategies.
• Set and adjust reserves with appropriate documentation.
• Identify red flags and elevate potential fraud concerns.
• Confirm insurance coverage and self-insured retention amounts.
• Identify and pursue subrogation and Second Injury Fund opportunities.
• Manage medical treatment, including provider network use and pre-approvals for surgery.
• Approve medical bills and calculate/pay indemnity benefits accurately and on time.
• Support early return-to-work efforts, including modified duty arrangements.
• Negotiate and settle claims within authority and process payments accordingly.
• Ensure compliance with N.J. statutes, company best practices, and client protocols.
• Communicate clearly and professionally with all parties involved.
• Stay current on New Jersey workers’ compensation laws and relevant case laws.

Skills

Customer service

Organization

Attention to detail

Negotiation

Analytical skills

Verbal communication

Written communication

Microsoft Office

Industry-related systems

Analyst licenses

Education

Associate degree

Bachelor's degree preferred

Tools

Microsoft Office Suite

Claims management systems

Job description

Job Description

Summary

The New Jersey Workers' Compensation Adjuster I handles Medical Only to lost time indemnity claims. Independently 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 also serves as a technical resource and advocate for client claim concerns.

Key Responsibilities

• Promptly investigate assigned Medical Only and lost time indemnity claims from routine to light-complexity with minimal supervision.
• Determine compensability in accordance with applicable jurisdictional requirements.
• Develop and maintain a resolution plan covering medical, indemnity, litigation, and settlement strategies.
• Set and adjust reserves with appropriate documentation.
• Identify red flags and elevate potential fraud concerns.
• Confirm insurance coverage and self-insured retention amounts.
• Identify and pursue subrogation and Second Injury Fund opportunities.
• Manage medical treatment, including provider network use and pre-approvals for surgery.
• Approve medical bills and calculate/pay indemnity benefits accurately and on time.
• Support early return-to-work efforts, including modified duty arrangements.
• Negotiate and settle claims within authority and process payments accordingly.
• Ensure compliance with N.J. statutes, company best practices, and client protocols.
• Communicate clearly and professionally with all parties involved.
• Stay current on New Jersey workers’ compensation laws and relevant case laws.

Requirements

• Associate degree and/or 3+ years of relevant claims experience required; bachelor’s degree preferred.
• Minimum 3 years of workers’ compensation claims handling experience.
• Public entity claims experience a plus.
• Strong customer service, organization, and attention to detail.
• Proficient in Microsoft Office and industry-related systems.
• Excellent written, verbal, analytical, and negotiation skills.
• Must maintain required analyst licenses as applicable.
• Candidates must be residents of NJ, PA, DE, TX, or FL.

Employee Benefits

• Paid time off
• Medical, dental, and vision insurance
• 401(k)
• HRA & FSA
• Group life, STD, and LTD insurance, and more!

Physical Requirements

Prolonged periods of desk/computer work

Equal Opportunity Employer

Claims Resolution Corporation, Inc. is an Equal Opportunity Employer. We are committed to inclusivity and provide employment opportunities to all qualified individuals regardless of race, creed, color, sex, sexual orientation, religion, national origin, age, disability, or any other status protected by law.