Sabio Systems is seeking an experienced and detail-oriented Senior Workers' Comp Adjuster for an established organization. This position is responsible for independently investigating, evaluating, managing, and resolving complex workers' compensation claims, including lost-time and litigated claims, from initial reporting through final resolution. The ideal candidate will have extensive experience handling workers' compensation claims, a thorough understanding of New Mexico workers' compensation laws and regulations, and the ability to manage complex caseloads while maintaining accuracy, compliance, and exceptional communication. This opportunity is well-suited for a proactive claims professional who possesses strong analytical and negotiation skills, exercises sound judgment, and can provide guidance and support to other claims professionals.

Responsibilities For Senior Workers' Comp Adjuster:

• Independently investigate, evaluate, manage, and resolve complex workers' compensation claims, including lost-time and litigated claims

• Review claim details, medical documentation, and supporting evidence to determine compensability, liability, and appropriate benefits

• Conduct timely investigations and communicate with employers, injured workers, medical providers, witnesses, and other involved parties

• Maintain accurate and comprehensive claim files, electronic documentation, and diary systems to ensure timely follow-up and compliance

• Monitor medical treatment for causation, reasonableness, necessity, and compliance with applicable treatment guidelines

• Review and authorize medical bill payments and coordinate medical case management referrals when appropriate

• Evaluate claim exposure and establish or adjust reserves based on claim developments and potential financial liability

• Ensure timely and accurate administration of workers' compensation benefits in accordance with applicable statutes and regulations

• Negotiate claim settlements with injured workers, attorneys, and other involved parties within established settlement authority

• Prepare for and participate in mediations, hearings, formal trials, and other claim-related proceedings

• Review and report claims requiring excess carrier notification and coordinate reimbursement requests when applicable

• Identify claims requiring Medicare Set-Aside consideration and ensure appropriate review and reporting

• Apply Official Disability Guidelines (ODG) when evaluating the appropriateness of medical treatment

• Identify unusual risk factors or safety concerns and communicate findings to appropriate personnel

• Minimum of seven (7) years of claims adjusting experience, preferably with significant experience handling workers' compensation claims

• Active New Mexico Adjusting License required

• Strong working knowledge of New Mexico workers' compensation laws, regulations, and Workers' Compensation Administration procedures

• Experience managing complex, lost-time, and litigated workers' compensation claims

• Knowledge of claims investigation, compensability determination, benefit administration, reserving, and settlement negotiation

• Experience reviewing medical documentation, evaluating treatment plans, and coordinating with healthcare providers

• Familiarity with workers' compensation litigation, mediations, and formal hearings

• Strong understanding of claims documentation requirements, regulatory deadlines, and compliance standards

• Bachelor's degree or an equivalent combination of postsecondary education and relevant professional experience

• Proficiency in Microsoft Office applications

• Valid New Mexico driver's license required