Complex Claims Adjuster (Workers' Compensation)

Location: Remote, but candidates must live and work in the United States; U.S. territories are excluded.

Salary: $100,000–$125,000 USD per year.

Company

hirify.global uses technology to make commercial insurance more affordable and accessible for small businesses.

What you will do

• Independently manage catastrophic and large-loss workers’ compensation claims from setup through closure.
• Investigate claims, determine compensability, administer benefits, and establish accurate reserves within authority limits.
• Manage defense counsel, litigation activity, legal costs, mediations, settlement conferences, and trials.
• Evaluate exposure using medical cost projections, Medicare Set-Asides, rated ages, present value, and structured settlements.
• Provide claim guidance, status updates, coverage verification, and loss-run reports to agents, insureds, and business partners.
• Improve claims processes, protocols, standard operating procedures, and mitigation strategies with Claims leadership.

Requirements

• High school diploma or equivalent required; a bachelor’s degree or equivalent experience with some college coursework is preferred.
• At least 7 years of workers’ compensation claim-adjusting experience, preferably with a carrier, including 2 or more years handling catastrophic claims.
• Active licenses in applicable states, with advanced knowledge of jurisdictional regulations, statutory requirements, and CMS/Medicare Set-Aside requirements.
• Advanced experience in claim adjudication, medical management, litigation management, complex negotiation, and exposure mitigation.
• Strong communication, analytical, problem-solving, and conflict-resolution skills, with the ability to work independently and mentor junior adjusters.
• Must live and work in the United States and have reliable, high-speed internet.

Nice to have

• Experience handling claims in the Southeast, especially Florida and Georgia.
• Experience with G-Suite tools and Slack.
• Willingness to expand jurisdictional knowledge and obtain additional state licenses as business needs evolve.

Culture & Benefits

• Health insurance plans and generous paid time off.
• Future-focused 401(k) matching.
• Parental and caregiver leave.
• Remote work with reliable high-speed internet.
• Potential discretionary bonuses for eligible team members based on company performance.
• AI-assisted application screening and interview note-taking are used with human oversight.