What does a workers' compensation claims adjuster do?
A worker's compensation claims adjuster is responsible for analyzing and validating compensation claims, ensuring eligibility and accuracy to authorize payments. Their responsibilities also include coordinating with different departments to gather data, liaising with internal and external parties, determining the amount of compensation, and negotiating claims. Furthermore, a worker's compensation claims adjuster may also perform administrative support tasks such as preparing progress reports and other documentation, answering calls and inquiries, maintaining records of all transactions, and training new members of the workforce.
Workers' compensation claims adjuster responsibilities
Here are examples of responsibilities from real workers' compensation claims adjuster resumes:
- Manage OSHA logs and insure ongoing awareness for warehouse safety and risk management guidelines
- Manage litigation, pay timely compensation, file necessary state forms timely, negotiate appropriate settlements within company assign authority.
- Adjust complex workers' compensation claims, which include litigation management, vocational rehabilitation, medical management, and reserving practices.
- Coordinate all medical and vocational rehabilitation services.
- Coordinate all provide medical and vocational rehabilitation services to the catastrophically injure worker.
- Prepare claims for hearing process order DWC.
- Prepare claims for the all hearings order by DWC.
- Communicate w/ medical providers, TPA and or attorneys.
- Obtain authorizations such as MRI studies and other pertinent testing.
- Coordinate payment and release of medical records to ensure HIPAA compliance.
- Input, modify deactivate new existing equipment PMS in the CMMS update forms.
- Implement plan to work with insure state by state for implementation of RTW program
- Order old charts from off site storage facility and scan into EMR system.
- Case management of client progress while maintaining confidentiality of records according to HIPPA laws.
- Compile employee time, production, and payroll data from time sheets and other records.
Workers' compensation claims adjuster skills and personality traits
We calculated that 28% of Workerss' Compensation Claims Adjuster are proficient in Customer Service, Claim Process, and Compensation Benefits. They’re also known for soft skills such as Detail oriented, Interpersonal skills, and Math skills.
We break down the percentage of Workerss' Compensation Claims Adjuster that have these skills listed on their resume here:
- Customer Service, 28%
Developed and introduced new customer service policies, which resulted in increased customer retention and improved customer satisfaction within a saturated market
- Claim Process, 16%
Authorized specialist referrals to expedite claim processing and mitigate long-term financial exposures of clients.
- Compensation Benefits, 12%
Determine eligibility of insurance coverage, compensation benefits, medical treatment, and medical billing payment.
- Settlement Authority, 9%
Negotiate settlements, and present recommendations to clients and insurance carriers for settlement authority.
- Data Entry, 4%
Case make-up, including data entry.
- Litigation, 4%
Manage litigation, pay timely compensation, file necessary state forms timely, negotiate appropriate settlements within company assigned authority.
Most workerss' compensation claims adjuster use their skills in "customer service," "claim process," and "compensation benefits" to do their jobs. You can find more detail on essential workers' compensation claims adjuster responsibilities here:
Detail oriented. The most essential soft skill for a workers' compensation claims adjuster to carry out their responsibilities is detail oriented. This skill is important for the role because "adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences." Additionally, a workers' compensation claims adjuster resume shows how their duties depend on detail oriented: "conducted detailed interviews of claimants, medical specialists and employers to determine compensability and consistent application of policy coverage. "
Interpersonal skills. Another essential skill to perform workers' compensation claims adjuster duties is interpersonal skills. Workerss' compensation claims adjuster responsibilities require that "adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering." Workerss' compensation claims adjuster also use interpersonal skills in their role according to a real resume snippet: "honed superior interpersonal skills to explain coverage(s) and policy language. "
Analytical skills. For certain workers' compensation claims adjuster responsibilities to be completed, the job requires competence in "analytical skills." The day-to-day duties of a workers' compensation claims adjuster rely on this skill, as "adjusters and examiners must each evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay." For example, this snippet was taken directly from a resume about how this skill applies to what workerss' compensation claims adjuster do: "managed caseload of claims, from inception through analysis, litigation and settlement. "
Communication skills. Another crucial skill for a workers' compensation claims adjuster to carry out their responsibilities is "communication skills." A big part of what workerss' compensation claims adjuster relies on this skill, since "claims adjusters and investigators must get information from a range of people, including claimants, witnesses, and medical experts." How this skill relates to workers' compensation claims adjuster duties can be seen in an example from a workers' compensation claims adjuster resume snippet: "provide quality customer service as well as keeping an open communication with the claimant throughout entire process. "
The three companies that hire the most workers' compensation claims adjusters are:
- Gallagher63 workerss' compensation claims adjuster jobs
- Sedgwick LLP55 workerss' compensation claims adjuster jobs
- State Auto Insurance
27 workerss' compensation claims adjuster jobs
Choose from 10+ customizable workers' compensation claims adjuster resume templates
Build a professional workers' compensation claims adjuster resume in minutes. Our AI resume writing assistant will guide you through every step of the process, and you can choose from 10+ resume templates to create your workers' compensation claims adjuster resume.
Compare different workerss' compensation claims adjuster
Workers' compensation claims adjuster vs. Insurance investigator
A claims investigator is responsible for examining and investigating in a particular insurance claim is valid. They ensure that the insurance company will settle claims as soon as possible. They resolve issues to prevent fraudulent allegations. This career also requires effective communication. Claims investigators must often conduct interviews.
There are some key differences in the responsibilities of each position. For example, workers' compensation claims adjuster responsibilities require skills like "customer service," "claim process," "compensation benefits," and "settlement authority." Meanwhile a typical insurance investigator has skills in areas such as "insurance claims," "insurance benefits," "general liability," and "scene investigations." This difference in skills reveals the differences in what each career does.
On average, insurance investigators reach higher levels of education than workerss' compensation claims adjuster. Insurance investigators are 5.6% more likely to earn a Master's Degree and 0.5% more likely to graduate with a Doctoral Degree.Workers' compensation claims adjuster vs. Disability examiner
A disability examiner is primarily in charge of conducting assessments and examinations to determine an applicant's eligibility for disability benefits and programs. Their duties usually include reviewing medical and health records, conducting interviews, and evaluating applications. There are also times when a disability examiner must directly coordinate with healthcare providers to obtain and assess records. Moreover, as a disability examiner, it is essential to assist clients by answering inquiries, providing instructions and advice, and helping them understand the extent of procedures.
Each career also uses different skills, according to real workers' compensation claims adjuster resumes. While workers' compensation claims adjuster responsibilities can utilize skills like "customer service," "claim process," "compensation benefits," and "settlement authority," disability examiners use skills like "social security disability," "supplemental security income," "social security administration," and "disability determinations."
Disability examiners earn a lower average salary than workerss' compensation claims adjuster. But disability examiners earn the highest pay in the government industry, with an average salary of $47,657. Additionally, workerss' compensation claims adjuster earn the highest salaries in the finance with average pay of $64,978 annually.disability examiners earn higher levels of education than workerss' compensation claims adjuster in general. They're 13.9% more likely to graduate with a Master's Degree and 0.5% more likely to earn a Doctoral Degree.Workers' compensation claims adjuster vs. Field investigator
A field investigator is responsible for collecting information and evidence to support ongoing investigations of law enforcement agencies. Field investigators analyze the occurrence and connections of criminal activities by gathering related cases and coordinating with scene witnesses. They also validate the information by conducting surveillance operations and coordinating with law professionals. A field investigator may also work for private clients, updating them regularly for the progress, and informing them of additional actions as needed to solve complicated cases.
Some important key differences between the two careers include a few of the skills necessary to fulfill the responsibilities of each. Some examples from workers' compensation claims adjuster resumes include skills like "customer service," "claim process," "compensation benefits," and "settlement authority," whereas a field investigator is more likely to list skills in "excellent time management," "background checks," "mental health," and "criminal justice. "
Field investigators earn the best pay in the insurance industry, where they command an average salary of $41,014. Workerss' compensation claims adjuster earn the highest pay from the finance industry, with an average salary of $64,978.When it comes to education, field investigators tend to earn higher degree levels compared to workerss' compensation claims adjuster. In fact, they're 6.0% more likely to earn a Master's Degree, and 0.1% more likely to graduate with a Doctoral Degree.Workers' compensation claims adjuster vs. Insurance examiner
A claims examiner is responsible for conducting a claim review of a client against a particular insurance company--usually a health and life insurance company. An examiner must review claims and then approve them, reject them, or develop a possible settlement. They need to communicate with policyholders and insurance agents to assess if all the information under the company's claims guidelines and policies are correct and accurate.
Types of workers' compensation claims adjuster
Updated January 8, 2025
