Workers' Compensation Adjuster

The Workers' Compensation Adjuster is responsible for managing and resolving workers' compensation claims promptly and effectively. This includes working collaboratively with internal and external business partners, evaluating coverage, determining liability, and coordinating benefits for injured workers while ensuring compliance with state and federal regulations. This individual will work cohesively with third-party administrators to manage claims outside of our self-insured program.

Job Responsibilities

• Determine the compensability of claims based on applicable workers' compensation laws.
• Set and maintain accurate reserves in accordance with company guidelines.
• Coordinate and authorize medical treatment and evaluations.
• Monitor medical progress and manage return-to-work timelines.
• Communicate with claimants, medical providers, attorneys, and other stakeholders.
• Review and interpret medical reports, wage statements, and legal documents.
• Maintain detailed and organized claim files and documentation in the claims management system.
• Negotiate settlements within authority limits and recommend strategies on settlements above limits for approval.
• Attend hearings, mediations, or depositions as required.
• Ensure timely payment of benefits such as temporary disability, permanent disability, and medical bills.
• Identify and pursue subrogation opportunities when applicable.
• Stay current on workers' compensation laws, rules, and industry best practices.
• Be a resource for the operations field team for injury and case management during and after normal business hours.

Qualifications

• Maine State workers' compensation adjuster license and/or commitment to obtain.
• 3-5 years of experience in disability case management or occupational health preferred.
• Strong understanding of ADA, FMLA, HIPAA, and other relevant laws and regulations.
• Excellent communication, organizational, and problem-solving skills.
• Ability to handle sensitive situations with empathy and discretion.
• Proficiency in Microsoft Office, Procore, and disability management software platforms.
• Ability to travel occasionally for case meetings and/or educational conferences.

Cianbro is an employee-owned, tobacco-free, equal opportunity employer, we do not discriminate based on marital status, race, color, creed, gender, sex, religion, national origin, gender identity, age, veteran status, union affiliation, physical or mental disability, citizenship status, sexual orientation, or genetic information.

Professionals