WC Complex Med Only Adjuster (Workers Compensation)

Location: Charlotte, North Carolina, with a hybrid schedule

Salary: USD $53,000–$68,000 per year

Company

hirify.global is a midsized U.S. property and casualty insurance company serving customers by helping mitigate losses and restore lives and businesses after insured events.

What you will do

• Investigate complex medical-only workers compensation claims through communication with insureds, claimants, employers, and medical providers.
• Determine coverage, compensability, medical causality, relatedness, subrogation potential, and the appropriate course of action.
• Establish and adjust reserves, evaluate claim exposure, process payments, administer benefits, and resolve claims generally involving exposure below $30,000.
• Manage disputed facts, denied claims, medical claim petitions, and claims requiring nurse consultation, diagnostics, or minor medical procedures.
• Document claim files, maintain diary controls, submit state forms, and keep claim and regulatory data accurate and current.
• Ensure compliance with company, state, and federal regulations, including electronic data exchange requirements with state and Medicare systems.

Requirements

• Knowledge of workers compensation statutes, insurance coverage, and case law.
• Working knowledge of medical treatment, medical terminology, injury mechanisms, and comorbidities related to medical-only claims.
• Critical-thinking skills for assessing claim compensability based on facts and applicable law.
• Excellent written and verbal communication skills.
• 1–3 years of claims experience preferred; a college degree is preferred.
• Experience handling claims in North Carolina, South Carolina, Georgia, Kentucky, Tennessee, Virginia, Arizona, Colorado, or Utah is preferred.

Culture & Benefits

• Hybrid work environment based in Charlotte.
• Competitive base salary and incentive plan eligibility.
• Comprehensive health care plans and retirement savings with company matching.
• Discounted employee stock purchase program.
• Tuition assistance and reimbursement programs.
• 20 days of paid time off.