Workers' Compensation Claims Adjuster

Workers' Compensation Claims Adjuster

Location: Denver, CO

Department: Risk Management / Claims Reports 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

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The YES Difference

Competitive salary | Comprehensive health benefits | Life, long and short-term disability insurance | 401(k) with company match

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