Sr. Workers Compensation Claims Adjuster
About the role
The Workers’ Compensation Claims Adjuster must be knowledgeable of the California Labor Code and administration of claims. It is the responsibility of a Workers' Compensation Claims Adjuster to receive and organize all documents related to the employee and the injury to make a determination regarding the claim. The Claims Adjuster is responsible for the prompt and efficient examination and investigation of claims. Workers' Compensation Claims Adjusters abide by company guidelines when making claim determinations. This is a remote opportunity that requires an active California Adjuster license supporting a dedicated account.
Responsibilities
- Assess coverage and review claims for purposes of investigations, action plans, evaluation, fraud, and claim resolution.
- Complete quality investigations by gathering pertinent information.
- Reviews and evaluates coverage and/or liability.
- Secures necessary information (i.e., reports, policies, releases, statements, or other documents) in the investigation of claims.
- Conduct a thorough analysis of liability and continually assess exposure and evaluate for accurate reserves.
- Works toward the resolution of claims files and takes full charge of claim from inception to resolution.
- Will affect settlements/reserves within prescribed limits and submits recommendations to supervisor on cases exceeding personal authority.
- Ensures that claims payments calculated accurately and are issued in a timely and accurate manner.
- Ensures compliance of claims handling pursuant to all state, legal, statutory, and regulatory bodies to comply with all company procedures and requirements.
- Maintains a diary to follow claim progress on all claims.
- Determine liability for permanent disability, mitigation of costs and resolution of claim.
- Oversee litigation and coordination of claim with defense team.
Qualifications
- 5+ years of experience handling workers’ compensation claims.
- Current California Adjuster Certification.
- Familiarity with state workers’ compensation laws and regulations.
Skills
- Strong skills in customer service
- Verbal and written communications
- Time management
- Organizational skills
- Excellent attention to detail
- Ability to work independently
- Strong knowledge of computers and software
Benefits
- Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.
- Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.
- Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.
- Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.
This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.
Pay
The base compensation range for this position is $95,000 - $1