Workers Compensation Claims Adjuster

• Investigate and manage workers’ compensation claims in New Jersey, New York, and Connecticut from inception through closure.
• Review claim documentation, accident reports, medical records, wage statements, and other relevant information to determine compensability.
• Establish appropriate reserves and adjust reserves as claims develop.
• Coordinate with employers, injured workers, medical providers, attorneys, nurse case managers, and other stakeholders.
• Monitor medical treatment plans and return-to-work opportunities.
• Evaluate exposure and negotiate settlements within designated authority limits.
• Manage litigated claims and work closely with defense counsel.
• Ensure compliance with all state workers’ compensation statutes, regulations, and reporting requirements.
• Maintain timely and accurate claim documentation in the claims management system.
• Prepare and submit required reports and correspondence.
• Participate in claim reviews, audits, and quality assurance initiatives.
• Identify potential fraud indicators and escalate concerns when appropriate.
• Meet established performance metrics for claim handling, diary management, customer service, and file quality.

• Minimum 3–5 years of workers’ compensation claims adjusting experience, including experience handling indemnity and medical-only claims.
• Bachelor’s degree in business, insurance, risk management, finance, or a related field is preferred.
• Demonstrated experience handling claims in New Jersey, New York, and/or Connecticut, with working knowledge of jurisdictional differences, filing requirements, compensability standards, and benefit administration.
• Strong knowledge of workers’ compensation laws, regulations, claims processes, medical management, return-to-work practices, and litigation management.
• Ability to independently investigate claims, evaluate exposure, establish and manage reserves, and negotiate settlements within delegated authority.
• Experience reviewing and interpreting medical records, wage documentation, legal correspondence, and investigative materials.
• Industry certifications such as AIC, CPCU, ARM, WCCP, or similar professional designations preferred.
• Active adjuster license(s), where required, or the ability to obtain and maintain required licenses for applicable jurisdictions.
• Experience handling litigated files, attending mediations or settlement conferences, and partnering with defense counsel on resolution strategy.
• Experience identifying subrogation, fraud indicators, and recovery opportunities.
• Demonstrated ability to meet performance metrics related to quality, timeliness, customer service, reserving accuracy, and closure rates.
• Intermediate proficiency in Microsoft Excel, including formulas and functions, sorting and filtering data, pivot tables, and basic reporting and analysis.
• Proficiency in Microsoft Outlook, Word, and claims management systems, with the ability to maintain timely, accurate, and well-documented electronic claim files.
• Strong verbal and written communication skills, including the ability to correspond professionally with claimants, clients, counsel, and medical providers.
• Excellent organizational, analytical, and time-management skills, with the ability to prioritize competing deadlines and manage diary follow-up effectively.
• Ability to work independently, exercise sound judgment, maintain confidentiality, and perform effectively in a fast-paced, high-volume claims environment.

This job description is intended to be an accurate representation of the general functions of the job, rather than exhaustive list of duties, responsibilities, or experience. Other duties may be assigned, requested, or required. Aspects of the job may be altered without notice.