WC Complex Med Only Adjuster

TL;DR

WC Complex Med Only Adjuster (Workers' Compensation): Investigate complex medical-only workers’ compensation claims to determine coverage, compensability, and subrogation potential with an accent on jurisdictional guidelines, reserve accuracy, and timely claim resolution. Focus on managing medical-only files across multiple jurisdictions, handling disputed facts and medical causality, and ensuring compliance with legal and regulatory requirements.

Location: Charlotte, North Carolina (Hybrid: 2 days in office, 3 days remote)

Salary: USD $55,000.00 - USD $68,000.00 /Yr.

Company

hirify.global is a U.S. domestic property and casualty insurance company.

What you will do

• Investigate assigned complex medical-only claims through communication with insureds, claimants, and medical providers to determine coverage, compensability, and subrogation potential.
• Handle mostly non-indemnity medical-only claims, including medical causality, denied claims, and medical claim petitions; occasionally manage minimal indemnity/permanency benefits.
• Establish and adjust reserves throughout the life of each file and evaluate exposure to ensure reserves remain appropriate.
• Process claims end-to-end: make contacts, set reserves, evaluate exposure, make timely payments, and resolve claims.
• Document claim files and maintain control of work using documentation/diary systems; complete required state forms on time.
• Ensure compliance with company, state, and federal regulations, including accurate and timely data updates for electronic data interchange with state and Medicare.

Requirements

• Knowledge of workers compensation statutes, coverage, and case law.
• Excellent written and verbal communication skills.
• Working knowledge of medical treatment and medical terminology as it relates to medical-only workers’ compensation claims.
• Critical thinking skills to assess compensability based on facts and law.
• 1–3 years claims experience preferred.
• College degree preferred.

Culture & Benefits

• Competitive base salary with incentive plan eligibility.
• Comprehensive health care plans and retirement savings plan with company match.
• Tuition assistance and reimbursement programs.
• 20 days of paid time off.
• Discounted Employee Stock Purchase Program.

Hiring process

• Interviews to assess claims experience, communication skills, and ability to evaluate medical-only workers’ compensation claims.
• Evaluation of fit for jurisdictional claim handling and compliance requirements.