Sr. Workers' Compensation Adjuster, CA

Responsibilities

• Conduct interviews with insured parties, claimants, witnesses, and other relevant individuals to assess claim eligibility
• Obtain statements; analyze coverage; determine compensability and applicable benefits
• Set appropriate reserves; negotiate settlements; manage indemnity and litigated claims including exposure analysis and settlement strategy
• Collaborate with defense counsel to evaluate exposure and drive claims toward timely and equitable resolution
• Maintain timely and accurate claim file documentation in accordance with company protocols
• Coordinate medical management, including UR/IMR and return-to-work strategies
• Prepare clear and professional written communications and reports
• Participate in claim reviews and case discussions
• Maintain diary system in accordance with company standards
• Coordinate medical management, including UR/IMR and return-to-work strategies
• Identify and address claims with Medicare exposure
• Identify and pursue subrogation opportunities
• Recognize potential fraud indicators (red flags) and refer cases to SIU as appropriate
• Assign and oversee vendor resources, ensuring quality and timeliness of services
• Communicate effectively with internal and external stakeholders and provide mentorship to junior staff

Qualifications

• 5+ years California workers’ compensation claims experience
• Experienced Adjuster Designation (preferred)
• Bachelor’s degree preferred

Core Skills

• Advanced knowledge of California workers’ compensation regulations and laws
• Ability to work independently and efficiently in a remote environment
• Excellent analytical and problem-solving abilities
• Effective verbal and written communication skills
• Negotiation skills
• Strong organizational and time management skills with ability to prioritize competing demands
• Proficiency with Microsoft Word, Excel, and Outlook
• Advanced mathematical calculations