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Job Category: Insurance

WORKERS’ COMPENSATION ADJUSTER

A workers’ compensation claim is usually filed for coverage of medical-related services received as a result of a work

related injury. It is the responsibility of a workers’ compensation claims adjuster to receive and organize all

documents related to the employee and the injury in order to make a determination regarding the claim.

Job Function

The worker’s compensation claims adjuster is responsible for handling workers’ compensation claims and

files. Once the claim is filed for an injured worker, the adjuster is responsible for determining whether the

worker was injured at work and whether the claim is compensable. If the claim is accepted, the adjuster

helps coordinate care for the injured worker by approving and authorizing treatment, surgery, medications

and appointments. The adjuster pays the bills on the file, which include wages to the injured worker for time

he is unable to work, payment to doctors and pharmacies, payments to attorneys for consulting and giving

legal advice on the file and any other payments that may occur within the scope of the claim. The adjuster

sends out legal notices as required by the state to inform the injured worker of his rights and anything he

may or may not be entitled to. The worker’s compensation claims adjuster works with the employer and the

employee to get the injured worker well and back to work, even if it’s in a light or modified position.

Work Environment

The worker’s compensation claims adjuster will be working in a cubicle, generally sitting the entire work shift

at a desk behind a computer.

Who They Work With

A worker’s compensation claims adjuster works hand in hand with a large number of people to treat an

injured worker and get her back to work. A worker’s compensation claims adjuster works with nurses and

doctors to help coordinate patient care and authorize treatment. They work with medical billers to ensure

bills are paid and services are billed correctly. A worker’s compensation adjuster works with employers and

employees. Depending on how complex the file becomes, an adjuster may also work with both defense and

plaintiff attorneys and paralegals. In some states, if the employee is unable to go back to her position due to

injury, training for a new position is required, and a claims adjuster is required to work with a vocational

counselor or schools to get the injured worker back to work.

Requirements

High school degree or the equivalent.

5-7 years experience adjusting WC claims.

Has to be bi-lingual

Excellent communication skills