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Workers' Compensation Indemnity Adjuster/Territory Rep (Hybrid)

Illinois Health and Hospital Association
United States, Illinois, Naperville
1151 East Warrenville Road (Show on map)
Jul 08, 2025

Main Function

Responsible for the administration of lost time/indemnity workers' compensation claims including but not limited to conducting a thorough investigation, managing medical care, and working towards final claims closure.

Outline of Responsibilities

  • Thoroughly investigate claims and make compensability and coverage decisions through 3-point contact with employee, employer and medical provider.
  • Effective communication both orally and in writing with clients, injured workers and provider offices.
  • Determine subrogation recovery opportunities and handle through conclusion.
  • Adjudicate medical bills.
  • Review and document all claims correspondence to proactively manage the claims
  • Ensure Indemnity payments are timely and appropriate.
  • Estimate and establish reserves on all claims for probably final payout.
  • Manage medical care to ensure reasonable and appropriate medical care.
  • Maintain a claim follow-up diary system.
  • Comply with excess reporting policies.
  • Proper use of the Pharmacy Benefit Manager program.
  • Proper use of in-house Telephonic Nurse Case Managers.
  • Ensure Medicare compliance on all claims.
  • Ensure EDI compliance on all claims
  • Facilitate in-person claim reviews, video meetings, and telecons with clients as requested.
  • Manage Allocated Loss Adjustment Expenses of claims.
  • Document claim activity in file notes including a solid current status and plan of action.
  • Provide prompt and efficient service to our clients on all client requests.
  • Properly close all claims once all claims issues are resolved.
  • Other duties as defined.

Qualifications

A high school diploma and three years of medical only workers' compensation experience and/or experience with lost time/indemnity claims required. Bachelor's degree and/or a certificate in a related insurance program preferred. Ability to independently multi-task in a fast-paced environment in the management of claims. Demonstrate independence and critical thinking that leads to appropriate judgment in the management of workers' compensation claims, along with a strong understanding of medical information and State Workers' Compensation Acts. Possess excellent oral and written communication skills, a strong attention to detail, as well as the ability to work well with others and be a positive team player. Adaptability to meet ever-changing needs of clients as well as an intermediate knowledge of Microsoft Office. Routine travel is required.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other legally protected status.

We offer a competitive compensation package, including excellent benefits. Qualified candidates must apply online: Click here to apply https://www.team-iha.org/our-association/employment-opportunities

Pay Range: $67,337 to $94,272 annually, actual compensation is dependent on job-related factors such as experience, education, skills and qualifications for the role.

IHA offers a full range of benefit programs based on eligibility. Click here to review our Benefit Summary.

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