Workers Compensation Senior Adjuster

Job Purpose or Objective: This role is responsible for analyzing claim data, setting financial reserves, approving payments, and coordinating with medical providers, legal representatives, and internal departments. Additionally, the Senior Adjuster plays a key role in case management, benefit calculations, and continuous process improvement to ensure effective and compliant claims administration. You will report to the Workers Compensation Manager.

Monday-Friday, 8:00am-4:30pm

- You will assist Manager on budget planning and reporting to department leadership.
- Oversee complex claims and provide expert guidance to adjusters in the resolution and handling of these cases.
- Analyze claim data—including employer reports, medical documentation, and associate interviews—to determine compensability.
- Review documentation to set appropriate reserves, determine reimbursement amounts for providers and team members, and calculate benefits such as injury leave and mileage for submission to accounting.
- You will testify in litigation matters within the Choctaw Nation court system.
- Review the Workers’ Compensation fee schedule, approve medical provider payments and third-party invoices, and coordinate reimbursement processing.
- You will assign complex claims to case managers and ensure timely updates and ongoing case oversight.
- Serve as the liaison between CNOSH and Workers' Compensation to ensure accurate and timely OSHA reporting and recordkeeping compliance.
- Coordinate internal case management activities involving CNHSA, CNOSH, and external medical providers to ensure comprehensive care and compliance.
- Perform all other duties as may be assigned.

MINIMUM
• Bachelors’ degree in General Studies or equivalent combination of education and experience
• Workers’ Compensation Adjuster License and/or ability to attain License within 90 days of hire
• Ability to determine compensability and the need for subrogation
• Excellent communication skills
• Knowledge of Workers’ Compensation Systems
• Knowledge of statutes to analyze situations accurately
• Knowledge of Medical Terminology
• Knowledge of Occupational Safety & Health recordkeeping requirements
• Five (5) years’ experience adjusting claims and reserving claims
• Bilingual proficiency preferred