Senior Claims Adjuster Workers' Compensation

Pay Philosophy

The typical starting salary for this position is determined by a number of factors including but not limited to acquired skills experience education and certifications/designations. This position may be eligible for annual merit increases and participation in our bonus program.

What are we looking for

Join our team as a Senior Claims Adjuster in Workers this position you will be responsible for independence investigations coverage interpretation and medical management in various state jurisdictions. This position is fully remote.

Who we are and what we do

At Columbia Insurance we believe our people are the heart of our success and our greatest strength. With robust benefits a fun family-like atmosphere and a culture that thrives on real connections Columbia truly is the place to be. Our vision is to lead the industry in people-first partnerships. The best way to achieve that is by bringing together a team of skilled passionate and talented individuals.

Why us

• Medical Dental and Vision coverage
• 401(k) and company match
• Generous paid time off (PTO) paid company holidays paid maternity/paternity leave and supplemental sick leave
• Family-like culture
• Year-round wellness initiatives
• Company sponsored events
• Opportunities for professional development with conferences events and continued education

Company History

Our legacy has roots back to 1889 when we first became part of the mutual insurance movement in the Midwest. Today our extensive heritage resonates nationwide as we proudly serve customers in 14 states across the country.

BASIC FUNCTION AND RESPONSIBILITY

The Sr. Claims Adjuster handles minor to complex workers compensation (WC) claims that may involve legal representation. This role involves independent investigation coverage interpretation and medical management in various state jurisdictions. This position handles claims with increased financial exposure and complexity as well as litigated claims. You will work closely with internal and external partners to resolve claims promptly fairly and within authority limits using modern claims technologies and best practices. This role serves as a promotional opportunity for experienced adjusters who demonstrate advanced technical knowledge sound judgment and the ability to independently manage larger losses.

ESSENTIAL FUNCTIONS

• Handle a diverse caseload including complex and moderate to high exposure workers compensation claims through final resolution.
• Promptly review new losses and determine initial plan of action.
• Maintain professional communication with internal partners agents policyholders and claimants providing updates and guidance throughout the claim lifecycle.
• Conduct in depthcoverage analysis involving manuscript policies endorsements and exclusions.
• Act as primary point of contact for insureds agents and vendors.
• Communicate coverage decisions and claim outcomes clearly and professionally.
• Prepare and submit required reports to state agencies including First Reports of Injury (FROI) and Subsequent Reports of Injury (SROI).

• Assess medical records physician reports and functional capacity evaluations to determine extent of disability on WC claims.
• Calculate temporary and permanent disability benefits according to state guidelines.
• Communicate disability determinations clearly to employees employers and medical providers.
• Recognize and escalate unusual catastrophic or high exposure losses as appropriate.
• Draft and issue reservation of rights letters coverage disclaimers and partial denial letters in accordance with company standards and regulatory requirements.
• Investigate and determine liability by collecting statements evidence coordinating expert inspections and reviewing contracts and statutes
• Conduct thorough investigations into injuries by interviewing insureds claimants witnesses; obtain and analyze police reports medical records employment records and other relevant documentation.
• Establish and adjust reserves as warranted to ensure accurate reserving commensurate with claim exposure.
• Review all expense bills for appropriateness accuracy and adherence to Company billing practices.
• Negotiate with claimants attorneys medical providers employers and other stakeholders to achieve fair timely settlements within authority limits.
• Verify accuracy of any payments within individual authority and secure approval when appropriate.
• Recognize notify and pursue other culpable parties and seek contribution as warranted.
• Work closely with defense counsel when appropriate in pre suit matters.
• Oversee third party service providers such as independent adjusters investigators and defense counsel to ensure cost effective and quality outcomes.
• Recommend appropriate settlement strategies for complex or high exposure claims.
• Serve as a technical resource and mentor to less experienced adjuster.
• Provide detailed file documentation/notes consistent with departmental guidelines.
• Maintain completed accurate and well documented claim files that reflect advanced analysis and decision making.
• Ensure compliance with state insurance regulations internal claim handling guidelines and service standards.
• Coordinate with claims leadership underwriting and loss control regarding risks and loss trends identified in the field.
• Participate in team meetings training and continuing education as required.
• Other duties as assigned.

REQUIRED QUALIFICATIONS

• 7 years of experience handling WC claims.
• Strong working knowledge of WC policy forms and endorsements and coverage analysis with experience handling moderate to complex coverage matters.
• Demonstrated experience handling moderate to high-severity WC claims involving complex damages and higher financial exposure.
• Proficient in policy interpretation exposure analysis and jurisdictional claims practices across multiple states and Texas specifically.
• Excellent negotiation analytical and customer service skills
• Ability to communicate clearly and professionally.
• Proven ability to manage challenging conversations with policyholders.
• Strong organizational and time-management skillS
• Technical knowledge of commercial insurance laws regulations and best practices.
• Proven ability to manage competing priorities in a fast-paced environment.
• Strong written and verbal communication skills with the ability to present information clearly and persuasively.
• Has sound critical thinking and problem solving capabilities.
• Outstanding customer service attention to detail and multi-tasking skills.
• Strong computer skills including a strong knowledge of Microsoft applications (Outlook Word Excel)
• Strong working knowledge of claims technology platforms.
• Must have a valid adjuster license in designated home state (or willing to obtain one within 60 days after hire) as well as a Texas license with the ability to obtain additional non residential adjuster licenses.Ability to exercise independent judgment with very limited supervision in handling claims with an elevatedreserve and settlement authority.
• Ability to travel as necessary.

PREFERRED QUALIFICATIONS

• Experience working in Guidewire Claim Center
• Professional designations such as AIC CPCU or equivalent.
• Experience mentoring or providing technical guidance to other adjusters.

EDUCATION QUALIFICATIONS

• Bachelors Degree recommended

EOE

Columbia Insurance prohibits discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race color religion sex sexual orientation gender identity or expression pregnancy age national origin disability status genetic information protected veteran status or any other characteristic protected by law.

If you are unable to complete the electronic application for any reason please contact Mandi Giboney: