Workers' Compensation Adjuster I

Summary:

The New Jersey Workers' Compensation Adjuster I handles Medical Only to lost time indemnity claims. Independently manages the investigation, evaluation, and resolution of workers’ compensation claims in compliance with legal statutes, policy terms, and client-specific instructions. The adjuster coordinates medical care, negotiates settlements, and works closely with claimants, clients, attorneys, and medical professionals to achieve timely, cost-effective outcomes. This role also serves as a technical resource and advocate for client claim concerns.

Key Responsibilities:

• Promptly investigate assigned Medical Only and lost time indemnity claims from routine to light-complexity with minimal supervision.
• Determine compensability in accordance with applicable jurisdictional requirements.
• Develop and maintain a resolution plan covering medical, indemnity, litigation, and settlement strategies.
• Set and adjust reserves with appropriate documentation.
• Identify red flags and escalate potential fraud concerns.
• Confirm insurance coverage and self-insured retention amounts
• Identify and pursue subrogation and Second Injury Fund opportunities.
• Manage medical treatment, including provider network use and pre-approvals for surgery.
• Approve medical bills and calculate/pay indemnity benefits accurately and on time.
• Support early return-to-work efforts, including modified duty arrangements.
• Negotiate and settle claims within authority and process payments accordingly.
• Ensure compliance with N.J. statutes, company best practices, and client protocols.
• Communicate clearly and professionally with all parties involved.
• Stay current on New Jersey workers’ compensation laws and relevant case laws.

Requirements:

• Associate degree and/or 3+ years of relevant claims experience required; bachelor’s degree preferred.
• Minimum 3 years of workers’ compensation claims handling experience.
• Public entity claims experience a plus.
• Strong customer service, organization, and attention to detail.
• Proficient in Microsoft Office and industry-related systems.
• Excellent written, verbal, analytical, and negotiation skills.
• Must maintain required analyst licenses as applicable.
• Candidates must be residents of NJ, PA, DE, TX, or FL

Employee Benefits:
We offer a comprehensive benefits package, including:

• Paid time off
• Medical, dental, and vision insurance
• 401(k)
• HRA & FSA
• Group life, STD, and LTD insurance, and more!

Physical Requirements:

• Prolonged periods of desk/computer work

Equal Opportunity Employer:
Claims Resolution Corporation, Inc. is an Equal Opportunity Employer. We are committed to inclusivity and provide employment opportunities to all qualified individuals regardless of race, creed, color, sex, sexual orientation, religion, national origin, age, disability, or any other status protected by law.