Claims Adjuster

This role requires strong analytical, communication, and decision-making skills to evaluate claims, determine liability, negotiate settlements, and ensure timely claim resolution while maintaining compliance with applicable policies and regulations. Conduct thorough investigations by gathering facts, interviewing claimants, insureds, witnesses, attorneys, medical providers, and other relevant parties.

Job Title: Claims Adjuster 4
Contract: W2
Location: Portland, OR
Work Arrangement: Hybrid 
Pay Range: $40 - $42 per hour 

Position Overview

We are seeking an experienced Claims Adjuster IV to manage workers’ compensation claims from investigation through resolution. This role requires strong analytical, communication, and decision-making skills to evaluate claims, determine liability, negotiate settlements, and ensure timely claim resolution while maintaining compliance with applicable policies and regulations.

Key Responsibilities

• Review claim and policy information to determine coverage, liability, and claim exposure.
• Conduct thorough investigations by gathering facts, interviewing claimants, insureds, witnesses, attorneys, medical providers, and other relevant parties.
• Analyze claim details and documentation to assess liability and determine appropriate claim outcomes.
• Prepare detailed reports documenting investigations, evaluations, settlements, denials, and claim activity.
• Establish and manage claim reserves within assigned authority levels and recommend adjustments when necessary.
• Identify and escalate unusual or potentially high-exposure claims.
• Negotiate and settle claims fairly, accurately, and in a timely manner.
• Obtain necessary documentation, including releases, proofs of loss, and settlement agreements.
• Issue claim payments and communicate claim decisions to customers, claimants, attorneys, and other stakeholders.
• Maintain accurate claim files and ensure adherence to established claims handling practices.

Qualifications

Required

• 2+ years of experience handling Workers’ Compensation claims.
• Strong investigative, analytical, and decision-making abilities.
• Excellent verbal and written communication skills.
• Ability to build professional relationships with claimants, insureds, brokers, attorneys, medical providers, and other stakeholders.
• Self-motivated with the ability to manage a workload independently and prioritize effectively.
• Knowledge of workers’ compensation claims processes, insurance coverages, and policy interpretation.

Preferred

• Experience managing complex or higher-exposure workers’ compensation claims.
• Familiarity with claim reserve management and settlement negotiations.
• Understanding of industry best practices and regulatory requirements related to claims handling.

Education & Experience

• Bachelor’s degree preferred; equivalent workers’ compensation insurance experience will also be considered.
• Relevant claims handling experience in a workers’ compensation environment.

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