Workers Compensation Claims Adjuster
More Information & ApplyJob 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.
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