Senior Workers’ Compensation Adjuster

JOB SUMMARY:

This position is responsible for a variety of professional duties in handling workers’ compensation claims in Georgia for Georgia Power, along with handling claims in Georgia for Southern Company Services, Southern Power, and Southern Communications, and providing backup workers’ compensation claim support for Southern Nuclear Company in both Georgia and Alabama. This role is responsible for investigating, analyzing, and managing claims, including determining compensability, handling indemnity, medical, financial exposure and payments, state form filings, Medicare reporting, working with defense counsel on legal/litigation issues, subrogation actions, excess/re-insurer reporting, Subsequent Injury Trust Fund (SITF) reporting, and other miscellaneous tasks. This role requires timely and thorough communication with a variety of stakeholders. This role requires a strong compliance component to follow federal laws and guidance, state laws and rules, and company processes and policies in handling claims.

Please Note: This is a hybrid position with in-office presence expectation at 241 Ralph McGill Blvd, Atlanta, GA. 

JOB REQUIREMENTS: 

Education:

• High School Diploma Required

• Associate Degree or Bachelor's Degree Desired

Work Experience:

• Minimum 5 years claims related experience in handling complex workers’ compensation claims required
• Ideal candidate will have claims experience in Georgia and Alabama
• Knowledge of accepted industry standards and practices

Preferred:

• Experience as a lost-time adjuster for a Third-Party Administrator or Self-Insured Company for 5+ years

MAJOR JOB RESPONSIBILITIES: 

 Functional Expertise:                                                                                                

• Partners with employees, leadership, Medical & Health Services, Safety, medical providers, vendors, and legal counsel to effectively manage and resolve claims

• Determines compensability and manages claims in accordance with Alabama and Georgia Workers’ Compensation laws, rules, and company policies

• Collaborates with external defense counsel to investigate claims and evaluate compensability based on case-specific facts and circumstances

• Serves as a cross-trained resource supporting Southern Nuclear Workers’ Compensation claims across Georgia and Alabama jurisdictions to ensure continuity and consistency

• Applies professional judgment to manage a broad range of complex claim types, including medical-only, lost-time, catastrophic, death, controverted, and litigated claims

• Calculates, analyzes, and manages claim financials, including historical spend and future reserve estimates

• Ensures timely and accurate processing of payments, including indemnity, medical, legal, and related expenses

• Identifies and proactively pursues claim resolution opportunities, including return-to-work strategies, settlements, and appropriate benefit discontinuation

• Evaluates claims for cost containment opportunities while ensuring appropriate and quality medical care

• Coordinates reimbursement and recovery efforts, including excess insurance, Subsequent Injury Trust Fund, and subrogation opportunities

• Communicates with Payroll to ensure proper handling of indemnity offsets and salary-in-lieu payments

• Maintains accurate and detailed claim documentation, including notes, action plans, and supporting information within claim systems

• Ensures compliance with all state and federal reporting requirements, including Georgia State Board filings and Medicare Section 111 reporting and CMS requests

• Supports required annual filings, including reporting for the State Board of Workers’ Compensation and the Self-Insured Guaranty Trust Fund

• Coordinates Medicare Set-Aside (MSA) reporting and funding and facilitates arrangements and communications

• Manages vendor setup processes, including requesting W-9s and obtaining billing information for payment processing

• Oversees medical management activities, including bill review approvals, pharmacy benefit management requests, and processing of employee reimbursements (e.g., mileage, out-of-pocket expenses)

• Utilizes automation tools, including Power Automate, to support and streamline workflows where appropriate

• Builds and maintains strong working relationships with external vendors, ensuring timely communication, responsiveness, and issue resolution

• Demonstrates the ability to quickly learn and effectively utilize claim systems and business applications, including Assure Claims, ICMS II, Oracle, Mobi, Medicare Section 111 reporting tools, third-party medical and pharmacy platforms, and Microsoft 365 applications (Outlook, Excel, Word, Forms, SharePoint, OneNote, Power Automate), with the expectation of ongoing learning as systems and processes evolve

Litigation:

• Serves as Company Representative for claims, including providing testimony at hearings, depositions, mediations, and other legal proceedings

• Partners closely with defense counsel by providing timely documentation, claim updates, and case strategy support

• Prepares and presents settlement evaluations to management to obtain appropriate settlement authority, and leads negotiations to resolve claims

• Evaluates claims for closure opportunities and develops resolution strategies

• Negotiates settlements with pro se claimants and supports counsel with requests in order to finalize settlement documentation and agreements

• Coordinates subrogation efforts with motor vehicle insurers and legal representatives when third-party liability exists 

• Communicates directly with opposing counsel, when appropriate, to support timely resolution and cost management of legal expenses

Business Acumen:

• Identifies, evaluates, and actively pursues reimbursement and recovery opportunities

• Calculates, reviews, and analyzes claim financials, including estimating and managing future reserves

• Balances attention to detail with the ability to effectively manage a high-volume caseload

• Maintains comprehensive claim documentation, including detailed notes and clear action plans

• Adapts quickly to evolving processes, systems, and workflows

• Builds and maintains strong, professional relationships with internal and external stakeholders, ensuring timely and appropriate responsiveness

• Collaborates with internal teams and external partners to resolve issues, process claims efficiently, complete required documentation, and bring claims to timely resolution

• Quickly learns new processes, documents key information through effective notetaking, and applies knowledge to daily work

• Demonstrates strong problem-solving skills and the ability to develop effective solutions in complex or unique situations

• Communicates clearly and professionally in writing, including drafting medical questionnaires and correspondence to physicians

• Exhibits excellent communication skills and works effectively in a collaborative team environment

• Manages calendars, diaries, and plans of action to ensure timely claim handling and compliance with deadlines

• Demonstrates a continuous learning mindset and adaptability as processes and business needs evolve

• Available and responsive to after-hours calls on a limited, as-needed basis

• Available to travel to offsite meetings, conferences, etc. as needed