Job Description

Job Description

Job Description

Are you a driven, ambitious, and energetic sales professional looking for your next challenge? Join Insurance Program Managers Group (IPMG) and become part of a dynamic team committed to innovation! For the past 27 years, our mission has been to create one-of-a-kind solutions for our partners. We bring proactive and tailored approaches to our clients, valuing the unique contribution of each team member. Together, we shape our identity and drive transformative change for our clients.

We are looking for a Senior Claims Adjuster to join our claims management division. This role is a full-time, exempt position responsible for performing technical work on intermediate to complex workers’ compensation, lost time, and litigated claims through resolution. 5+ years lost time/indemnity claims handling experience is mandatory for this role. This is a work from home hybrid position with 2-3 required weekly days in office based on performance production.

Essential Functions

• Ensures Claims Best Practices guidelines are consistently followed
• Ensures defined processes, quality standards and procedures are consistently followed
• Initiates contact with employers, injured employees, doctors, witnesses, and other parties, to secure investigation and details about the claim
• Timely and proactively determines compensability or denial of the claim
• Reviews all new claims within 1-2 business days with 24-48 hours contact with injured worker
• Obtains and reviews medical records and claim related correspondences and determines appropriate action for each case
• Maintains files notes in accordance with established procedures, maintains timely diary management, timely reserve evaluations, ensures claim closing objectives are met, including other defined performance objectives
• Provides timely information to clients, claimants, doctors, and others regarding the status of claims
• Review, revise and document ongoing needed reserve changes in timely fashion
• Reports qualified exposures to excess carriers based on program needs and guidelines
• Analyzes first reports of injury to determine the nature of the loss, compensability, and scope of the injury for adequate reserving and actions needed
• Utilizes Nurse Case Management as needed for complex claims and follows through with agreed service level agreements (SLA) between departments, including timely authorization of managed care action items
• Works with Risk Management Services to ensure lost time / modified duty opportunities are maximized
• Works with defense counsel regarding questionable compensability scenarios and IME doctor selection
• Identifies subrogation opportunities and reviews all necessary documentation, contacts all appropriate parties, and refers all subrogation opportunities to the Subrogation Specialist
• Effectuates accurate and timely claim transfer to new adjuster as prescribed by client service plan and/or Best Practices Guidelines with proper transfer documentation
• Recognizes clients that participate in occupational health structures with compliance to their respective special protocols
• Effectively negotiates settlements and utilizes defense partners when appropriate
• Proactively manages defense counsel on litigated claims matters in accordance with our litigation handling guidelines
• Issues attorney assignment letters on all litigated matters and ensures proper reporting, case evaluation and budget adherence by defense counsel
• Maintain Medicare screens to meet Section 111 requirements
• Ensure qualifying cases have Medicare Set Aside agreements in place
• Maintains other proper coding in claim screens as required by program and claim guidelines
• Completes 90-day interface claim reviews with quality and timeliness
• Well versed in multiple jurisdictions (where applicable)

• Recognizes clients that issue state specific benefits and ensures timely TTD payments are issued with adherence to client reimbursement protocols as warranted

• Communicate effectively with all internal and external business partners
• Written and verbal communication is professional and timely
• Communicate effectively in a clear and concise manner in one-one and group discussions while listening attentively in collaborative discussions
• Foster a sense of energy, urgency, ownership, and personal commitment to work
• Periodic participation in client claim reviews and/or teleconferences
• Assembly and presentation of client claim reviews with occasional travel
• Timely follow-through on all agreed action items with internal and external stakeholders that have been committed to fully execute on commitments made
• Supports special division projects as needed
• Achieves all metric goals outlined by department manager

Nonessential Functions

• Additional tasks as requested by management

Compensation and Benefits

• Salary range is $70,000 - $79,000 annually. Pay will be based on experience.
• 20 days of PTO each year.
• 2025 includes 13 paid holidays and YOUR BIRTHDAY OFF!
• Medical, dental, and vision coverage on day one of full-time employment.
• Telemedicine is free for you and your family (day one) if you are covered under our medical plan.
• 401k match.
• Professional development support.
• Flexible time off with an encouraged minimum time away to support a healthy work-life balance.
• Life Insurance, Short term, and long-term disability on day one of full-time employment.
• Onsite fitness center and showers, in our St. Charles, IL HQ office.

Our Interview Process

May we suggest you review our website ahead of our contact at and check us out on LinkedIn too to see what we are up to lately. Our goal is to meet the real YOU! We want to learn what makes you tick and how you want to grow in your field. And, we will share more about IPMG and answer any of your questions. If we feel we have a match, you will have a chat with our hiring manager to discuss the technical nature of the position to ensure you have the skills needed to be a success.

All About IPMG

IPMG is committed to a diverse and inclusive workplace. IPMG is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, religion, or other legally protected status.

Candidates that are selected and hired will need to submit to substance, credit, and criminal background screenings, and computer literacy testing.

IPMG is an Equal Opportunity Employer—M/F/D/V.

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