Claims Management
• Manage of caseload including complex or high-exposure workers’ compensation claims through investigation, evaluation, negotiation, and resolution.
• Determine compensability, calculate benefits, and authorize medical and indemnity payments in accordance with state laws and company policy.
• Coordinate treatment plans, return-to-work programs, and settlement strategies with medical providers, attorneys, TBG members, and vendors.
• Maintain detailed documentation in the claims management system and ensure timely reporting and compliance with regulatory requirements.
• Participate in mediations, settlement conferences, and hearings as needed, often in collaboration with outside counsel.
• Collaborate with internal medical, legal, and risk management resources to ensure optimal claim outcomes.
• Identify opportunities for early intervention, cost containment, and fraud prevention.
• Educate members on claims trends, loss drivers, and best practices for injury prevention.
• Collaborate cross-functionally with underwriting, account management, and loss control to deliver coordinated client solutions.
Compliance and Best Practices
• Ensure full compliance with applicable federal, state, and local workers’ compensation laws and regulations. Adhere to internal policies, procedures, and service standards.
• Stay informed on industry changes, case law, medical guidelines, and legislative updates.
• Maintain required adjuster licenses and participate in continuing education and professional development.
• Contribute to the development and refinement of claims handling procedures and client service protocols.
• Promote ethical conduct and high-quality claim management at all times.
QUALIFICATIONS/SKILLS:
• High School diploma or equivalent required, College degree preferred.
• 3+ years of workers’ compensation claims handling experience preferred.
• Must have a Minnesota Adjusters License.
• Experience in client-facing roles such as account management, claims consulting, or relationship management preferred.
• Prior experience mentoring or training others is a strong plus.
• Multi-jurisdictional claims experience desirable.Minimum of one (1) to two (2) years Workers’ Compensation lost time claims adjusting experience, or equivalent experience.
• Ability to coordinate and prioritize daily workflow of a moderate technical complexity.
• Must be detail oriented and a self-starter with strong organizational abilities.
• Excellent written and oral communication skills.
• Proficient using Microsoft Office programs such as Word, Excel, Outlook, etc.
• Ability to work with initiative in a mostly independent environment.
• Working knowledge of claim procedures, policies, terminology, etc.
• Working understanding of differences in techniques, medical care available and vocational possibilities within geographic areas of the state.
• Demonstrate problem-solving and analytical ability.
• Spanish bilingual desirable or other languages.
• Ability to travel as necessary.
• Ability to negotiate, build consensus and resolve conflict.
• Ability / willingness to acquire a valid MN State adjusting license.
• Sit, stand, walk/ambulatory; ability to lift 10 pounds.
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