Claims Adjuster - Workers’ Compensation

Claims Adjuster – Workers’ Compensation

Location: Remote
Contract Duration: 3 Months
Pay Rate: $35.00–$40.00 per hour

Important Requirement

An active Nevada Workers’ Compensation Adjuster license is mandatory.

Job Summary

We are seeking an experienced Workers’ Compensation Claims Adjuster to manage mid- to higher-level workers’ compensation claims from initial review through resolution. The successful candidate will be responsible for determining compensability and benefits, managing claim action plans, coordinating return-to-work efforts, monitoring reserves, handling subrogation, and negotiating settlements.

The ideal candidate will have strong knowledge of workers’ compensation regulations, excellent communication and negotiation skills, and the ability to independently manage complex claims while maintaining high service standards.

Key Responsibilities

• Manage workers’ compensation claims and determine compensability and benefits due.
• Handle long-term indemnity claims and monitor reserve accuracy.
• Develop and manage claim action plans through resolution.
• Coordinate return-to-work efforts and approve claim payments.
• Process assigned claims in accordance with applicable regulations and requirements.
• Identify and manage subrogation opportunities.
• Negotiate claim settlements when appropriate.
• Communicate claim status and actions with claimants and clients.
• Ensure claim files are accurately documented and properly coded.
• Prepare and submit required documentation and filings to state agencies.
• Handle complex lifetime medical and/or defined-period medical claims as assigned.
• Review treatment recommendations and make appropriate claim decisions in coordination with utilization review processes.
• Maintain professional client relationships.
• Support applicable quality programs and service standards.
• Travel as required.

QualificationsRequired

• Active Nevada Workers’ Compensation Adjuster license.
• At least 4 years of claims management experience, or an equivalent combination of education and experience.
• Strong working knowledge of workers’ compensation regulations and claims processes.
• Knowledge of offsets, deductions, disability duration, medical management practices, and applicable Social Security and Medicare procedures.
• Excellent verbal and written communication skills.
• Strong analytical, organizational, and problem-solving abilities.
• Excellent negotiation and interpersonal skills.
• Proficiency with Microsoft Office and standard computer applications.
• Ability to work effectively both independently and as part of a team.
• Ability to meet or exceed service expectations.

Preferred

• Bachelor’s degree from an accredited college or university.
• Experience handling mid- to high-level or complex workers’ compensation claims.
• Experience with long-term indemnity, medical, subrogation, and settlement claims.

Pay: $35.00 - $40.00 per hour

Application Question(s):

• Do you have an active Nevada Workers’ Compensation Adjuster license?

Work Location: Remote