Job Description

JCW Group has partnered with a specialty insurance carrier to hire a Senior Workers’ Compensation Claims Adjuster for a temporary, fully remote Claims assignment. The role adjudicates higher-complexity indemnity workers’ compensation claims for customers in Washington DC under limited technical direction and with potential impact on departmental results. It is a fit for an experienced workers’ compensation adjuster who can handle complex indemnity claims and drive them to the best financial outcome.

Key Responsibilities

• Adjudicate highly complex indemnity workers’ compensation claims while working under limited technical direction and within broad limits and authority, on assignments with potentially significant impact on departmental results.
• Report to senior management and underwriters on claims trends and developments.
• Investigate claims promptly and thoroughly, including interviewing all involved parties, and analyze claims forms, policies and endorsements, client instructions, and other records to determine whether the loss falls within the policy coverage.
• Manage claims in litigation.
• Manage diary timely and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
• Set claim reserves properly.
• Identify, assign, and coordinate expertise resources to assist in case resolution.
• Prepare reports for file documentation.
• Negotiate settlements.
• Complete calls and written correspondence to and from various parties, including the insured and the claimant.

Must-Have Qualifications | DC license required at start of assignment

• An advanced knowledge of adjudicating workers’ compensation claims, demonstrated through the following:
• A minimum of 5 years’ experience adjudicating workers’ compensation claims in the DC jurisdiction is required.
• Bachelor’s degree from an accredited university required. Two or more insurance designations, or four additional years of related experience adjudicating indemnity claims beyond the minimum experience required above, may be substituted in lieu of a degree.
• Good business acumen, meaning an understanding of how an insurance company works and makes money, including how this role impacts both the organization’s and its customers’ ability to be profitable.
• Excellent communication skills and the ability to build lasting relationships.
• Natural curiosity.
• A desire to work in a fast-paced environment.
• Excellent evaluation and strategic skills required.
• Strong claim negotiation skills a must.
• A strong customer focus.
• Effective time management skills and the ability to prioritize workload while handling multiple tasks and deadlines.
• Ability to articulate the financial value of your work at multiple responsibility levels inside the clients’ business, which may include the CEO.
• Ability to work independently and demonstrate the ability to exercise sound judgment.
• Demonstrated inner strength, with the courage to do the right thing and the willingness to demonstrate it on a daily basis.
• Intellectual curiosity, consistently considering all options and not being governed by conventional thinking.
• Proficiency in the MS Office Suite and other business-related software.
• Polished and professional written and verbal communication skills.
• The ability to read and write English fluently is required.
• A demonstrated desire for continued professional development through continuing education and self-development opportunities.

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