Workers' Compensation Claims Analyst

Aurora Health Care; Oak Brook (IL); On-site; USD 65,000 - 90,000; Full time

Job summary

Aurora Health Care in Illinois is seeking a Workers' Compensation Adjuster to manage complex lost-time claims across multiple jurisdictions. You will analyze claims, determine compensability, and ensure timely actions within state rules while maintaining strict confidentiality.

The role emphasizes accuracy, urgency, cost control, and collaboration with injured teammates and leaders. A valid adjuster license and a bachelor’s degree or equivalent experience are required, with 2–5+ years in a

Qualifications

• Must hold an adjusters license for the assigned jurisdiction.
• Bachelor’s degree required, or equivalent combination of education and experience.
• 2–5+ years’ experience managing progressively difficult Workers' Compensation lost time claims.

Responsibilities

• Must possess analytical skills and work with urgency and accuracy, adhering to state workers’ compensation rules.
• Complete appropriate contacts within 24 hours, establish diary for follow-up, evaluate compensability within statutory periods across jurisdictions.
• Monitor and control costs, document electronic claim files, reserve files, manage subrogation and litigation, and file forms for benefits.
• Serve as a resource to injured teammates, leaders and stakeholders on claims.
• Communicate claim status to injured teammates and other parties as necessary.
• Develop action plans for prompt payment/denial and monitor reports to excess carriers.
• Determine appropriate treatment and authorize related expenses, redirect to network physicians as needed.
• Maintain confidentiality of sensitive PHI information.
• Build professional customer relationships and mentor other adjusters and stakeholders.
• Provide support for additional projects and duties as assigned.

Skills

Analytical skills

Urgency & accuracy

Multijurisdiction experience

Claim status communication

Mentorship/leadership

Education

Adjusters license

Bachelor’s degree or equivalent experience

Job description

Major Responsibilities:

• Must possess analytical skills and be able to work with a sense of urgency and accuracy. Must be able to adhere to multiple state workers’ compensation rules, regulations, and laws.
• Must be able to complete appropriate contacts within 24 hours of assignment, establish and maintain appropriate diary for follow-up, evaluates and determines compensability of workers’ compensation claims within the statutory period for multiple jurisdictions.
• Must be able to be responsible for monitoring and controlling costs, timely documentation of the electronic claim file, claim outcome, timely reserving of files, managing subrogation and litigation, filing appropriate forms and payment of all benefits due within statutory periods and coordinates light duty as needed.
• Must function as a resource to the injured teammates, leaders, and others with an interest in the claim.
• Must be able to communicate claim status with the injured teammate and other parties, as necessary.
• Must be able to develop action plans and strategies for prompt payment/denial of claims bringing them to a timely conclusion while providing all appropriate information. Must be able to monitor and report appropriate claims to excess carriers.
• Must be able to determine what treatment is appropriate and causally related to the compensable injury and redirect treatment to network physicians as appropriate. Must be able to promptly authorize and approve related expenses of the claim.
• Must be able to maintain strict confidentiality of information at all times of a sensitive nature and/or protected under state and federal law.
• Must be able to develop and maintain professional customer relationships. Must be able to provide education as needed and serve as a mentor to other adjustors and stakeholders.
• Must be able to provide additional support for additional projects and duties as assigned.

Education Requirements:

• Adjusters license for assigned jurisdiction as required by specific jurisdiction as applicable.
• Bachelor’s degree required or a combination of education and related experience.

Experience Requirements:

• 2-5+ years’ experience managing progressively difficult Workers Compensation lost time claims. Associates in Claims designation preferred.

Knowledge, Skills & Abilities Required:

• Must be competent in workers’ compensation rules, regulations, and laws for multiple jurisdictions.
• Must work with a sense of urgency and accuracy.
• Evaluates and determines compensability of workers’ compensation claims within the statutory limits for multiple jurisdictions.
• Must be able to work independently as well as part of a team.
• Access to protected Health Information (PHI) to the extent of information necessary to do the job. Information shared only on a need-to-know basis.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.