Job Details

Job Description

Overview:
A well-established Third-Party Administrator (TPA), is seeking an experienced Senior Workers' Compensation Claims Adjuster to join their team supporting a New England accounts. This role is fully remote and requires a seasoned claims professional who can independently manage a complex Vermont workers' compensation caseload while delivering excellent service to both the client and injured workers.

The ideal candidate will have strong knowledge of New England workers' compensation statutes, proven experience handling litigated and complex claims, and the ability to manage claims from inception through resolution.

Compensation:

• $80,000 - $95,000/year
• Annual Bonus Potential
• 100% Remote Work Environment
• Comprehensive benefits package
• Opportunity to support a stable, long-term dedicated account
• Collaborative and supportive claims leadership team

• 5+ years of Workers' Compensation Claims Adjusting experience, with either MA, CT, NH, VT, ME, or RI claim handling required.
• Strong understanding of New England Workers' Compensation regulations and claims procedures.
• Experience handling complex and litigated claims.
• Prior experience working for a TPA or insurance carrier preferred.
• Strong organizational, analytical, and negotiation skills.
• Ability to manage a full caseload independently in a remote work environment.
• Active adjuster license or ability to obtain quickly.

• Manage a full caseload of New England workers' compensation claims from inception to closure.
• Investigate claims thoroughly to determine compensability and appropriate reserves.
• Ensure all claims are handled in compliance with New England workers' compensation laws and regulatory requirements.
• Coordinate and communicate with injured workers, employers, medical providers, attorneys, and other stakeholders.
• Establish and adjust reserves based on claim developments and exposure.
• Direct medical management, including coordination with nurse case managers when appropriate.
• Evaluate claims for settlement opportunities and participate in negotiations when necessary.
• Manage litigated claims, working closely with defense counsel to develop strategies and control costs.
• Maintain accurate claim documentation and provide timely claim updates to the client.
• Deliver high levels of customer service to a dedicated client account while meeting all service standards and KPIs.