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.
- 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,