Sr. Workers Compensation Claims Adjuster

Job Description

Job Description

Salary: $60,000-$90,000

Company Overview:
Claims Resolution Corporation, Inc. is a full-service third-party administrator (TPA) based in Galloway, New Jersey. We manage multi-line claims for both public and private entities across NJ, PA, DE, and NY. Our valuesclient-focused service, ethical conduct, and relationship-driven partnershipsare at the core of everything we do.

Job Summary:
We are seeking a seasoned Senior Workers Compensation Claims Adjuster to manage a caseload primarily in Pennsylvania. This role requires independent evaluation, investigation, and resolution of workers compensation claims, ranging from straightforward cases to complex medical and indemnity files. Success in this role demands thorough investigation, strong medical coordination, confident negotiation, and excellent communication with all involved parties. This position is primarily hybrid or in-person; however, a remote work option may be considered for candidates residing in NJ, PA, or DE.

Key Responsibilities:

• Conduct prompt and thorough investigations of medical and indemnity claims.
• Make timely compensability determinations in compliance with applicable jurisdictional laws.
• Document action plans, reserve changes, insurance coverage info, and SIR involvement.
• Identify potential fraud and alert management accordingly.
• Coordinate medical treatment, pre-authorizations, and review medical bills.
• Calculate and issue indemnity benefits in a timely and accurate manner.
• Negotiate and finalize settlements within authority; issue awards and settlements.
• Maintain consistent and professional communication with claimants, providers, attorneys, employers, and clients.

Qualifications:

• Associates or bachelors degree preferred.
  
• Public entity experience strongly preferred.
• Active or eligible to obtain required adjuster licenses.
• Strong attention to detail and investigative mindset.
• Excellent written, verbal, and interpersonal communication skills.
• Proficient in Microsoft Office, internet-based systems, and claims software.

Physical Requirements:

• Prolonged periods of sitting and computer work.

Growth and Development:
We support lifelong learning and offer training and tools to help our team grow and succeed.

Employee Benefits:
We offer a comprehensive benefits package, including:

• Paid time off
• Medical, dental, and vision insurance
• 401(k)
• HRA & FSA
• Group life, STD, and LTD insurance, and more!

Equal Opportunity Employer:
Claims Resolution Corporation, Inc. is an Equal Opportunity Employer. We are committed to inclusivity and provide employment opportunities to all qualified individuals regardless of race, creed, color, sex, sexual orientation, religion, national origin, age, disability, or any other status protected by law.