Columbia Insurance

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Join our team as a Senior Claims Adjuster in Worker's Compensation. In this position, you will be responsible for independent investigations, coverage interpretation, and medical management in various state jurisdictions. This position is fully remote. Qualifications - 7+ years of experience handling WC claims. - Strong working knowledge of WC policy forms and endorsements, and coverage analysis with experience handling moderate to complex coverage matters. - Demonstrated experience handling moderate to high-severity WC claims involving complex damages and higher financial exposure. - Proficient in policy interpretation, exposure analysis, and jurisdictional claims practices across multiple states and Texas, specifically. - Excellent negotiation, analytical, and customer service skills. - Ability to communicate clearly and professionally. - Proven ability to manage challenging conversations with policyholders. - Strong organizational and time-management skills. - Technical knowledge of commercial insurance laws, regulations, and best practices. - Proven ability to manage competing priorities in a fast-paced environment. - Strong written and verbal communication skills, with the ability to present information clearly and persuasively. - Sound critical thinking and problem-solving capabilities. - Outstanding customer service, attention to detail, and multi-tasking skills. - Strong computer skills, including a strong knowledge of Microsoft applications (Outlook, Word, Excel). - Strong working knowledge of claims technology platforms. - Must have a valid adjuster license in designated home state (or willing to obtain one within 60 days after hire), as well as a Texas license, with the ability to obtain additional non-residential adjuster licenses. - Ability to exercise independent judgment with very limited supervision in handling claims with elevated reserve and settlement authority. - Ability to travel, as necessary. Requirements - Handle a diverse caseload, including complex and moderate to high exposure workers' compensation claims through final resolution. - Promptly review new losses and determine initial plan of action. - Maintain professional communication with internal partners, agents, policyholders, and claimants, providing updates and guidance throughout the claim lifecycle. - Conduct in-depth coverage analysis involving manuscript policies, endorsements, and exclusions. - Act as primary point of contact for insureds, agents, and vendors. - Communicate coverage decisions and claim outcomes clearly and professionally. - Prepare and submit required reports to state agencies, including First Reports of Injury (FROI) and Subsequent Reports of Injury (SROI). - Assess medical records, physician reports, and functional capacity evaluations to determine extent of disability on WC claims. - Calculate temporary and permanent disability benefits according to state guidelines. - Communicate disability determinations clearly to employees, employers, and medical providers. - Recognize and escalate unusual, catastrophic, or high exposure losses as appropriate. - Draft and issue reservation of rights letters, coverage disclaimers, and partial denial letters in accordance with company standards and regulatory requirements. - Investigate and determine liability by collecting statements, evidence, coordinating expert inspections, and reviewing contracts and statutes. - Conduct thorough investigations into injuries by interviewing insureds, claimants, witnesses; obtain and analyze police reports, medical records, employment records, and other relevant documentation. - Establish and adjust reserves as warranted to ensure accurate reserving commensurate with claim exposure. - Review all expense bills for appropriateness, accuracy, and adherence to Company billing practices. - Negotiate with claimants, attorneys, medical providers, employers, and other stakeholders to achieve fair, timely settlements within authority limits. - Verify accuracy of any payments within individual authority and secure approval when appropriate. - Recognize, notify, and pursue other culpable parties and seek contribution as warranted. - Work closely with defense counsel when appropriate in pre-suit matters. - Oversee third-party service providers such as independent adjusters, investigators, and defense counsel to ensure cost-effective and quality outcomes. - Recommend appropriate settlement strategies for complex or high exposure claims. - Serve as a technical resource and mentor to less experienced adjusters. - Provide detailed file documentation/notes consistent with departmental guidelines. - Maintain completed, accurate, and well-documented claim files that reflect advanced analysis and decision making. - Ensure compliance with state insurance regulations, internal claim handling guidelines, and service standards. - Coordinate with claims leadership, underwriting, and loss control regarding risks and loss trends identified in the field. - Participate in team meetings, training, and continuing education as required. - Other duties as assigned. Benefits - Medical, Dental, and Vision coverage. - 401(k) and company match. - Generous paid time off (PTO), paid company holidays, paid maternity/paternity leave, and supplemental sick leave. - Family-like culture. - Year-round wellness initiatives. - Company sponsored events. - Opportunities for professional development with conferences, events, and continued education.