Claims Adjuster-Remote

The candidate will have experience in mid- to high-complexity workers compensation claim adjudication, Nevada regulations, subrogation, reserving, return-to-work coordination, and settlement negotiation and a proven ability to determine compensability and benefits, maintain accurate reserves and documentation, and drive timely claim resolution in alignment with standards and best practices.

Responsibilities:

• Analyze mid- and higher-level workers compensation claims to determine compensability and benefits due.
• Develop and manage action plans to resolution, including return-to-work coordination and approval of payments.
• Monitor and maintain reserve accuracy and file required documentation with the state agency.
• Identify and manage subrogation and negotiate settlements.
• Approve and process assigned claims pursuant to client contract and company standards.
• Communicate claim strategy, status, and actions with claimants and clients.
• Ensure proper file documentation and correct claims coding.
• Process complex lifetime or defined-period medical claims, including state and physician filings and utilization review recommendations.
• Maintain professional client relationships and support organizational quality programs.
• Travel as required.

Required Skills & Qualifications:

• Active Nevada workers compensation adjuster license. Remote considered only if licensed in NV. Onsite preferred.
• Bachelor's degree preferred or equivalent experience.
• Four (4) years of claims management experience or equivalent combination of education and experience.
• Working knowledge of workers compensation regulations, offsets and deductions, disability duration, medical management practices, and applicable Social Security and Medicare procedures.
• Proficiency with Microsoft Office and claims systems; strong analytical and interpretive skills.
• Excellent oral and written communication, including presentation skills; effective interpersonal and negotiation skills.
• Strong organizational skills with the ability to manage multiple priorities and meet deadlines in a team environment.
• Ability to meet or exceed Service Expectations.

Preferred Skills:

• Experience handling long-term indemnity and complex medical claims in Nevada.
• Background in subrogation strategy and settlement negotiations.

BCforward is a leading workforce solutions company connecting skilled professionals with top employers nationwide. We are committed to empowering careers through meaningful opportunities, professional growth, and exceptional support throughout the employment journey.