Claims Management

• Manage of caseload including complex or high-exposure workers’ compensation claims through investigation, evaluation, negotiation, and resolution.

• Determine compensability, calculate benefits, and authorize medical and indemnity payments in accordance with state laws and company policy.

• Coordinate treatment plans, return-to-work programs, and settlement strategies with medical providers, attorneys, TBG members, and vendors.

• Maintain detailed documentation in the claims management system and ensure timely reporting and compliance with regulatory requirements.

• Participate in mediations, settlement conferences, and hearings as needed, often in collaboration with outside counsel.

• Collaborate with internal medical, legal, and risk management resources to ensure optimal claim outcomes.

• Identify opportunities for early intervention, cost containment, and fraud prevention.

• Educate members on claims trends, loss drivers, and best practices for injury prevention.

• Collaborate cross-functionally with underwriting, account management, and loss control to deliver coordinated client solutions.

Compliance and Best Practices

• Ensure full compliance with applicable federal, state, and local workers’ compensation laws and regulations. Adhere to internal policies, procedures, and service standards.

• Stay informed on industry changes, case law, medical guidelines, and legislative updates.

• Maintain required adjuster licenses and participate in continuing education and professional development.

• Contribute to the development and refinement of claims handling procedures and client service protocols.

• Promote ethical conduct and high-quality claim management at all times.

QUALIFICATIONS/SKILLS:

• High School diploma or equivalent required, College degree preferred.

• 3+ years of workers’ compensation claims handling experience preferred.

• Must have a Minnesota Adjusters License.

• Experience in client-facing roles such as account management, claims consulting, or relationship management preferred.

• Prior experience mentoring or training others is a strong plus.

• Multi-jurisdictional claims experience desirable.Minimum of one (1) to two (2) years Workers’ Compensation lost time claims adjusting experience, or equivalent experience.

• Ability to coordinate and prioritize daily workflow of a moderate technical complexity.

• Must be detail oriented and a self-starter with strong organizational abilities.

• Excellent written and oral communication skills.

• Proficient using Microsoft Office programs such as Word, Excel, Outlook, etc.

• Ability to work with initiative in a mostly independent environment.

• Working knowledge of claim procedures, policies, terminology, etc.

• Working understanding of differences in techniques, medical care available and vocational possibilities within geographic areas of the state.

• Demonstrate problem-solving and analytical ability.

• Spanish bilingual desirable or other languages.

• Ability to travel as necessary.

• Ability to negotiate, build consensus and resolve conflict.

• Ability / willingness to acquire a valid MN State adjusting license.

• Sit, stand, walk/ambulatory; ability to lift 10 pounds.