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

1. You will assist Manager on budget planning and reporting to department leadership.
2. Oversee complex claims and provide expert guidance to adjusters in the resolution and handling of these cases.
3. Analyze claim data—including employer reports, medical documentation, and associate interviews—to determine compensability.
4. 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.
5. You will testify in litigation matters within the Choctaw Nation court system.
6. Review the Workers’ Compensation fee schedule, approve medical provider payments and third-party invoices, and coordinate reimbursement processing.
7. You will assign complex claims to case managers and ensure timely updates and ongoing case oversight.
8. Serve as the liaison between CNOSH and Workers' Compensation to ensure accurate and timely OSHA reporting and recordkeeping compliance.
9. Coordinate internal case management activities involving CNHSA, CNOSH, and external medical providers to ensure comprehensive care and compliance.
10. 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

• 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