Job Description

Job Description

Job Description

Description:

Worker’s Compensation Adjuster

Midwest Family Mutual Insurance Company is seeking a skilled and experienced Worker’s Compensation Claims Adjuster. This is a telework (work-from-home) position, ideal for a motivated professional who can operate independently with minimal supervision.

Applicants must have a minimum 3 years of experience handling Workers' Compensation lost time claims, including litigation. A dedicated home office space and high-speed internet access are required.

Midwest Family currently writes Workers’ Compensation in the following states: AZ, CO, IA, ID, IL, IN, KS, MN, MO, MT, NE, NM, OR, SD, UT, and WI, with recent expansions into KY, MI, and PA. Experience handling claims across multiple jurisdictions is highly preferred. Experience in South Dakota (SD), Arizona (AZ), and Colorado (CO) is a plus.

Essential Job Functions

The Workers’ Compensation Claims Adjuster is responsible for managing claims efficiently while ensuring fair and equitable outcomes and regulatory compliance.

1. Investigate and Evaluate Claims

• Confirm coverage and gather relevant facts through interviews and documentation review.
• Assess eligibility and injury severity to determine compensation according to statute.
• Review and analyze medical records to support claim decisions.

2. Manage Claims Process

• Establish and adjust loss reserves appropriately.
• Negotiate fair and equitable settlements with claimants and their representatives.
• Maintain clear, accurate documentation of all activities and communications.
• Monitor vendors and attorneys for performance and cost-effectiveness.

3. Coordinate Medical Care

• Approve necessary treatments and collaborate with medical providers.
• Support timely return-to-work initiatives when possible.

4. Legal and Regulatory Compliance

• Maintain compliance with state Workers’ Compensation laws and internal procedures.
• Prepare and submit required regulatory state filings and internal processes and procedures.
• Handle disputes and participate in mediation or hearings as needed to reach fair and equitable resolutions.

5. Financial Oversight

• Monitor claim costs and ensure timely payment of medical bills and benefits.
• Pursue subrogation and liens when appropriate.

6. Communication and Service

• Respond promptly and professionally to all inquiries from stakeholders.
• Provide ongoing support to injured workers throughout the claims process.

7. Continuous Improvement

• Maintain compliance through continued training on laws, regulations, and best practices.
• Identify and implement process improvements to enhance claim outcomes.

Requirements:

• Ability to work as part of a team.
• Regular and reliable attendance.
• Perform other duties as may be assigned.
• Bachelor’s degree preferred.
• Minimum 3 years of experience handling Workers' Compensation lost time claims.
• Dedicated home office space and high-speed internet access.
• Strong knowledge of Workers' Compensation coverage, legal and medical terminology, and relevant laws.
• Proven ability to negotiate timely, fair, and equitable settlements.
• Proficient in Microsoft Office with solid keyboarding skills.
• Excellent written and verbal communication skills.

Midwest Family Mutual offers a competitive salary and robust benefits package, including 401(K), and a Pension Plan.

Job Tags

Work at office, Remote work, Home office,

Similar Jobs