Pay Philosophy
The typical starting salary for this position is determined by a number of factors, including, but not limited to, acquired skills, experience, education, and certifications/designations. This position may be eligible for annual merit increases and participation in our bonus program.
What are we looking for?
Join our team as a Senior Claims Adjuster in Worker's Compensation. In this position you will be responsible for independence investigations, coverage interpretation, and medical management in various state jurisdictions. This position is fully remote.
Who we are and what we do?
At Columbia Insurance, we believe our people are the heart of our success and our greatest strength. With robust benefits, a fun, family-like atmosphere, and a culture that thrives on real connections, Columbia truly is the place to be. Our vision is to lead the industry in people-first partnerships. The best way to achieve that is by bringing together a team of skilled, passionate, and talented individuals.
Why us?
- 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
Company History
Our legacy has roots back to 1889 when we first became part of the mutual insurance movement in the Midwest. Today, our extensive heritage resonates nationwide, as we proudly serve customers in 14 states across the country.
BASIC FUNCTION AND RESPONSIBILITY
The Sr. Claims Adjuster handles minor to complex workers’ compensation (WC) claims that may involve legal representation. This role involves independent investigation, coverage interpretation, and medical management in various state jurisdictions. This position handles claims with increased financial exposure and complexity, as well as litigated claims. You will work closely with internal and external partners to resolve claims promptly, fairly, and within authority limits, using modern claims technologies and best practices. This role serves as a promotional opportunity for experienced adjusters who demonstrate advanced technical knowledge, sound judgment, and the ability to independently manage larger losses.
ESSENTIAL FUNCTIONS
- 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 adjuster.
- 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.
