Job#: 3057548 Job Description: Lost-Time Claims Adjuster
Location: Birmingham, Alabama (On-site)
Role Overview
The Lost-Time Claims Adjuster must independently administer and manage workers' compensation lost-time claims from initial report through closure. This professional will evaluate compensability, conduct detailed investigations, and manage return-to-work efforts to ensure optimal claim resolution. This position requires active, hands-on claim ownership within a collaborative, small-team environment.
Key Responsibilities
- Evaluate compensability and liability on complex workers' compensation lost-time claims.
- Conduct thorough investigations, obtain statements, and establish accurate reserves.
- Coordinate medical treatment and actively manage return-to-work initiatives.
- Process lost-time benefits and authorize appropriate medical and indemnity payments.
- Assign nurse case management, legal counsel, or surveillance when appropriate.
- Negotiate claim settlements and manage litigated files to successful resolution.
- Ensure strict compliance with state workers' compensation regulations, NCCI guidelines, EDI, and CMS reporting.
- Maintain clear and consistent communication with insureds, injured workers, medical providers, and legal counsel.
Required Qualifications
Education: Bachelor's degree is preferred, or an equivalent combination of education and experience.
Experience: Five or more years of dedicated workers' compensation claims adjusting experience with a preferred degree, or approximately ten years of experience without a degree.
Licensing and Certifications: An active Adjuster's License is required.
Technical Skills: Proficient understanding of EDI, CMS/Medicare, NCCI, and state reporting requirements is necessary. Strong general technical aptitude is required to navigate claims management software.
Preferred Qualifications
- Strong Tennessee workers' compensation jurisdictional knowledge and experience.
- Proven settlement management and litigation handling expertise.
- Experience operating in a monoline workers' compensation environment handling claims from intake through resolution.
- AIC or other insurance continuing education designations.
Everforth Apex is a world-class IT services company that serves thousands of clients across the globe. When you join Everforth Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRateds Best of Staffing in Talent Satisfaction in the United States and Great Place to Work in the United Kingdom and Mexico.
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Everforth Apex Benefits Overview: Everforth Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Everforth Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Everforth Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Everforth Apex team member can provide.
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