Cynet Systems · 2 weeks ago
Claims Adjuster - Workers Compensation - Remote / Telecommute
United States
Full-time
Remote
Mid LevelCynet Systems is a company specializing in claims management, and they are seeking a Claims Adjuster for Workers Compensation. This role is responsible for managing workers’ compensation claims from initial investigation through resolution, ensuring compliance with state regulations and maintaining communication with all stakeholders.
EmploymentRecruitingStaffing Agency
Responsibilities
Manage workers’ compensation claims, including determining compensability and benefits on long-term indemnity claims
Monitor reserve accuracy and file required documentation with state agencies
Develop and manage claim action plans through resolution
Coordinate return-to-work efforts and approve claim payments
Approve and process assigned claims in accordance with claim or client contracts
Manage subrogation and negotiate claim settlements
Communicate claim actions with claimants and clients
Ensure claim files are accurately documented and properly coded
Process complex medical claims, including state and physician filings and treatment determinations based on utilization review
Maintain professional relationships with clients and stakeholders
Support organizational quality programs and perform other assigned duties
Qualification
Required
End-to-end management of lost time and indemnity workers' compensation claims
Experience reserving claims for ultimate exposure
Ability to manage active caseloads, diaries, and correspondence
In-depth knowledge of Pennsylvania and New Jersey workers' compensation statutes, regulations, and case law
Experience with state-specific workers' compensation forms and EDI filings
Strong understanding of wage loss and benefit calculations, including average weekly wage and disability benefits
Experience coordinating medical treatment, utilization review, and compliance with state fee schedules
Experience handling litigated claims, working with defense counsel, and participating in hearings
Strong return-to-work coordination experience with employers
Excellent documentation, customer service, and communication skills
Experience negotiating settlements, including lump-sum agreements and compromise resolutions
Strong jurisdictional knowledge of workers' compensation regulations
Effective negotiation and settlement skills
Excellent written and verbal communication
Strong organizational and documentation skills
Ability to manage complex claims and multiple priorities effectively
Company
Cynet Systems
Headquartered in Washington DC Metro Area, Cynet Systems is a top talent supplier for companies across North America.
Founded in 2010
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Ashwani (Ash) M.
Partner and Co-CEO
Nikhil "Nick" Budhiraja
Founder / Co-CEO
Company data provided by crunchbase