Sr. Workers' Compensation Adjuster, CA

Investigate Coverage and Determine Compensability

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; and manage indemnity and litigated claims including exposure analysis and settlement strategy, in compliance with California Regulations.

Manage Indemnity and Litigated Claims

• Establish and maintain appropriate reserves
• 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
• Care for claims with Medicare exposure
• Pursue subrogation opportunities
• Identify and address potential fraud indicators (red flags) and refer cases to SIU as appropriate
• Assign and oversee vendor resources, ensuring quality and timeliness of services

Accountabilities

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

Pay Range

Anticipated Hiring Range: $79,500 - $110,000 annual base salary depending on experience, qualifications, and geographic location

Benefits

• Competitive base salary plus incentive plans for eligible team members
• 401(K) retirement plan that includes a company match of up to 6% of your eligible salary
• Free basic life and AD&D, long-term disability and short-term disability insurance
• Medical, dental and vision plans to meet your unique healthcare needs
• Wellness incentives
• Generous time off program that includes personal, holiday and volunteer paid time off
• Flexible work schedules and hybrid/remote options for eligible positions
• Educational assistance

Equal Opportunity Employer

The Mutual Group is an Equal Opportunity Employer. It is our policy to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.