Workers' Compensation Claims Adjuster

Workers' Compensation Claims Adjuster
Location: Denver, CO
Department: Risk Management / ClaimsReports To: Senior Claims Manager, or VP of Risk Management
Position Summary
The Workers' Compensation Claims Adjuster is responsible for managing a caseload of workers' compensation claims from initial report through closure. This role conducts timely investigations, evaluates compensability, directs medical management, establishes reserves, negotiates settlements, and coordinates return-to-work efforts while ensuring compliance with applicable state workers' compensation laws.
The ideal candidate possesses strong multi-state claim-handling expertise, sound judgment, return-to-work coordination, OSHA awareness and annual reporting, excellent communication skills, and a proven ability to manage complex claims involving lost time, and litigation.
Essential Duties and Responsibilities
Claim Investigation and Management

Administer a caseload of workers' compensation claims from inception through resolution.
Conduct thorough investigations to determine compensability and liability.
Obtain and review accident reports, witness statements, medical records, and employment documentation.
Analyze claim facts and applicable statutes to make timely compensability determinations.
Establish and adjust reserves based on claim exposure and ongoing developments.
Monitor claim progress and ensure file documentation is complete and accurate.

Medical and Disability Management

Coordinate medical treatment with healthcare providers, nurse case managers, and injured employees.
Review medical records and assess treatment plans for appropriateness and necessity.
Monitor temporary total disability, temporary partial disability, permanent partial disability, and permanent total disability exposures.
Facilitate return-to-work and transitional duty programs.
Collaborate with Human Resources and operations teams regarding work restrictions and accommodations.

Litigation and Settlement Management

Manage litigated claims in partnership with defense counsel.
Attend mediations, settlement conferences, hearings, and depositions as required.
Evaluate settlement opportunities and negotiate resolutions within authority limits.
Prepare settlement recommendations and management summaries for high-exposure claims.
Manage Medicare Set-Asides (MSAs), structured settlements, and lien resolutions when applicable.

Financial Management

Establish and maintain accurate claim reserves.
Work with HR and Carrier on authorizing payments for indemnity, medical expenses, and allocated expense costs.
Monitor claim costs and identify opportunities for cost containment.

Compliance and Reporting

Maintain accurate and timely file documentation.
Prepare claim status reports and management updates.
Monitor statutory deadlines and reporting requirements.

Multi Department Collaboration

Partner with Human Resources, Safety, and Operations departments.
Identify trends and recommend corrective actions to reduce claim frequency and severity.
Participate in accident review discussions and loss prevention initiatives.
Provide guidance to managers regarding injury reporting and claims procedures.

Qualifications
Education

Bachelor's degree in Risk Management, Insurance, Business Administration, Human Resources, or related field preferred.
Equivalent combination of education and experience will be considered.

Experience

Minimum 3-5 years of workers' compensation claims handling experience.
Experience managing lost-time and litigated workers' compensation claims required.
Multi-state claim handling experience preferred.

Knowledge, Skills, and Abilities

Extensive knowledge of workers' compensation laws and claims practices.
Strong investigation, negotiation, and analytical skills.
Ability to interpret medical records and evaluate treatment plans.
Experience managing reserves and claim financial exposure.
Strong organizational and time-management skills.
Excellent verbal and written communication abilities.
Ability to effectively interact with employees, attorneys, medical providers, and management.
Proficiency with Microsoft Office Suite and claims management systems. Riskonnect experience is a plus.

Preferred Certifications

Associate in Claims (AIC)
Associate in Risk Management (ARM)
Chartered Property Casualty Underwriter (CPCU)
Certified Workers' Compensation Professional (CWCP)
Workers' Compensation claims handling license(s), where required

Key Performance Indicators (KPIs)

Litigation management effectiveness
Return-to-work success rate
Regulatory compliance performance
Timeliness of claim investigations and documentation