Workers Compensation Claims Adjuster

Imagine Staffing Technology; United States; À distance; USD 75 000 - 102 000; Temps partiel

Résumé du poste

Imagine Staffing Technology is seeking an experienced Workers’ Compensation Claims Adjuster for a contingent, remote assignment in the United States. Ideal candidates have 3–4 years of Oregon WC claims handling and Oregon certification preferred.

The role involves adjudicating claims, managing documentation, and coordinating return-to-work efforts while maintaining clear communication with all parties involved.

Qualifications

• High School Diploma or GED required.
• Bachelor’s degree preferred.
• Oregon certification preferred.
• 3–4 years of workers’ compensation claims handling experience in Oregon required.
• Equivalent combination of education and claims management experience will be considered.
• Strong understanding of Oregon workers’ compensation regulations, offsets, and disability duration.
• Knowledge of medical management practices and Social Security/Medicare procedures related to workers’ compensation.
• Excellent oral and written communication skills, including the ability to deliver professional presentations.
• Proficient in Microsoft Office and claims management software systems.
• Strong analytical, organizational, and negotiation skills.
• Ability to work both independently and collaboratively in a team environment.
• Commitment to meeting and exceeding service expectations.

Responsabilités

• Manage and adjudicate workers’ compensation claims, including determining compensability, calculating benefits, and ensuring accurate reserves.
• Monitor and file all necessary state-required documentation within statutory deadlines.
• Develop and implement detailed action plans for timely claim resolution, including coordination of return-to-work efforts.
• Approve claim payments and settlements in accordance with authority guidelines.
• Identify and manage subrogation opportunities and negotiate settlements to reduce client exposure.
• Maintain consistent communication with claimants, employers, medical providers, attorneys, and clients.
• Ensure claim files are accurately documented and properly coded.
• Handle complex lifetime medical and defined-period medical claims, including reviewing state and physician filings and evaluating treatment recommendations from utilization reviews.
• Foster and maintain professional client relationships and deliver high-quality service.

Connaissances

Analytical skills

Communication skills

Negotiation skills

Microsoft Office

Claims software

Independent & team work

Formation

High School Diploma or GED

Bachelor’s degree

Oregon certification

Outils

Microsoft Office

Claims management software

Description du poste

Job Description

Job Profile

Job Title: Claims Adjuster

Location: Remote anywhere in US

Hire Type: Contingent

Pay Range: $40 - $45

Work Model:Remote

Work Shift: Monday-Friday 8 am – 4:30 pm

Nature & Scope:

Positional Overview

We are seeking an experienced Workers’ Compensation Claims Adjuster to join our team for a contingent assignment. The ideal candidate will have 3–4 years of relevant Oregon workers’ compensation claims handling experience and preferably hold Oregon certification. This role involves analyzing mid- to high-level claims, determining benefits due, ensuring compliance with state requirements, and managing claims through resolution while maintaining exceptional client and claimant communication.

Role & Responsibility:

Tasks That Will Lead to Your Success

• Manage and adjudicate workers’ compensation claims, including determining compensability, calculating benefits, and ensuring accurate reserves.
• Monitor and file all necessary state-required documentation within statutory deadlines.
• Develop and implement detailed action plans for timely claim resolution, including coordination of return-to-work efforts.
• Approve claim payments and settlements in accordance with authority guidelines.
• Identify and manage subrogation opportunities and negotiate settlements to reduce client exposure.
• Maintain consistent communication with claimants, employers, medical providers, attorneys, and clients.
• Ensure claim files are accurately documented and properly coded.
• Handle complex lifetime medical and defined-period medical claims, including reviewing state and physician filings and evaluating treatment recommendations from utilization reviews.
• Foster and maintain professional client relationships and deliver high-quality service.

Skills & Experience

Qualifications That Will Help You Thrive

• High School Diploma or GED required.
• Bachelor’s degree preferred.
• Oregon certification preferred.
• 3–4 years of workers’ compensation claims handling experience in Oregon required.
• Equivalent combination of education and claims management experience will be considered.
• Strong understanding of Oregon workers’ compensation regulations, offsets, and disability duration.
• Knowledge of medical management practices and Social Security/Medicare procedures related to workers’ compensation.
• Excellent oral and written communication skills, including the ability to deliver professional presentations.
• Proficient in Microsoft Office and claims management software systems.
• Strong analytical, organizational, and negotiation skills.
• Ability to work both independently and collaboratively in a team environment.
• Commitment to meeting and exceeding service expectations.