Adjuster, Workers' Comp

SUMMARY Processes workers' compensation claims from initial report through resolution. Determines compensability within established guidelines, calculates benefits such as lost wages, and coordinates routine claim activities. Maintains accurate claim records and provides timely updates to employees and internal stakeholders. Supports prompt, compliant, and consistent claim handling to ensure injured employees receive appropriate benefits while helping the District manage costs and maintain a safe, productive work environment.

ESSENTIAL DUTIES AND RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Gather initial loss information, including contact and demographic information. Investigate mechanism of injury and evaluate compensability and insurance coverage. Interview injured workers, supervisors, and third-party witnesses as part of investigation.

• Ensure appropriate reserves are set. Review reserve recommendations with supervisor when exceeding authority limit.

• Use the risk management information system (RMIS) to manage claim status, progress notes, and action plans. Leverage system capabilities to provide automated notifications where appropriate and to conduct analysis on trends and areas of focus.

• Perform claims adjustment in a collaborative and responsive manner, ensuring that internal stakeholders receive regular updates and communication that help them understand the process and potential outcomes.

• Complete and submit appropriate state forms following the Colorado Division of Workers' Compensation (DOWC) regulations in a timely fashion.

• Determine reasonable and necessary medical treatment and lost time payments. Evaluate need for and schedule independent medical exams (IMEs) and division independent medical exams (DIMEs) based on progression of recovery and medical treatment. Refer records reviews and Nurse Case Managers (NCMs) to claims as necessary.

• Provide support to injured workers', their managers, and HR Partners, including regarding work status - phrasing. Communicate off work statuses with leaves and payroll. Calculate average weekly wage (AWW) and issue indemnity payments as required by Colorado DOWC.

• Evaluate need for and assign social media checks, physical surveillance, SIU involvement, etc. Determine when claims may need to be assigned to defense counsel. Direct discovery and litigation process with counsel for the best resolution possible.

• Evaluate claims for potential settlement. Work to resolve claims within authority when possible and review with supervisor when value exceeds authority.

• Retain and maintain working knowledge of District's insurance policies; federal, state, and local laws related to insurance claims; District policies; and employee contracts and agreements by obtaining and reading periodicals and state legislature acts.

• Perform other duties as assigned.

REQUIREMENTS EXPERIENCE
3 years of experience in workers' compensation claims adjusting.

EDUCATION AND TRAINING
High School degree required. Additional college coursework equivalent to an Associate's Degree or higher preferred.

CERTIFICATES, LICENSES, OR REGISTRATIONS
None required. ARM (Associate in Risk Management), ARM-P (Associate in Risk Management for Public Entities) certifications preferred.

KNOWLEDGE, SKILLS AND ABILITIES
Knowledge of Colorado Division of Workers' Compensation (DOWC) basic regulations, required forms, and standard filing deadlines. Knowledge of District insurance policies and the fundamental components of workers' compensation coverage and compensability. Knowledge of basic medical and insurance terminology used to process treatment requests, calculate average weekly wages, and identify the need for medical exams. Knowledge of the administrative steps and document preparation required for claims litigation. Skilled in the technical operation of Risk Management Information Systems (RMIS) for data entry, note-taking, and generating status reports. Skilled in gathering and verifying demographic data, contact information, and initial injury reports from various parties. Skilled in performing accurate mathematical calculations for indemnity payments and tracking reserve levels against authority limits. Skilled in coordinating logistics for independent medical exams (IMEs), social media checks, and surveillance assignments. Ability to provide clear, responsive customer service to injured workers, HR partners, and payroll staff regarding claim status. Ability to identify and flag complex issues that require escalation to a supervisor. Ability to maintain organized electronic and physical files while ensuring the confidentiality of sensitive medical and personal data.

The physical requirements, mental requirements and work environment factors described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

PHYSICAL REQUIREMENTS
Ability to focus on objects at varying distances and distinguish between colors (with corrective lenses). Perform tasks that require manual dexterity, including operation of computers & small office equipment. Basic mobility and the ability to navigate the office environment safely. Ability to speak clearly, listen attentively (with assistance devices), and convey information accurately. May be required to give presentations to groups.

MENTAL REQUIREMENTS
Ability to analyze complex situations, identify potential risks, and devise effective solutions. Ability to remain flexible in dynamic environments, adjusting plans and strategies as necessary to accommodate changing requirements or circumstances. Ability to effectively communicate and collaborate with other teams. Ability to manage time and priorities to meet deadlines.

WORK ENVIRONMENT
Work is performed in a semi-secured office building with a typical office environment and risk factors. Some travel to local schools may be required.