Worker's Compensation Claims Adjuster III

Essential Duties and Responsibilities

• Perform a three-point contact on all new losses within 24 hours of receipt of the claim to include the claimant, employer, and treating physician to document relevant facts surrounding the incident itself as well as disability and treatment status.
• Thoroughly and accurately document ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and what is being done to move the case toward closure.
• Assure that all assigned indemnity claims have an up to date plan of action outlining activities and actions anticipated for ultimately resolving the claim.
• Form a partnership with the medical case manager to maximize early return to work potential thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs.
• Initiate the referral to the SIU of cases with suspected fraud.
• Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.
• Assure that the claim file is handled totally in accordance with applicable statutes as well as in-force service contracts and company guidelines.
• Review and approve all vocational rehabilitation plans.
• Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.
• Review all medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file.

Competency

• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Uses reason even when dealing with emotional topics.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Responds to requests for service and assistance; Meets commitments.
• Interpersonal - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
• Team Work - Supports everyone's efforts to succeed.

Qualification Requirements

• Education and/or Experience: Bachelor's degree (B. A.) from four-year college or university; at least seven years related experience and/or training; or equivalent combination of education and experience. Requires a high degree of claims handling expertise to include a minimum of at least five years experience managing indemnity cases, many with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues & possess an SIP certificate.

Salary Range

• $90,000-$100,000 annually

Benefits

• Comprehensive medical, dental, and vision benefits
• Company contributions to HSA and FSA plans
• Employer paid life and disability insurance
• 401(k) with company match
• Paid time off (PTO) and company paid holidays
• Learning and development opportunities that support real career advancement
• Employee assistance resources and a supportive culture that values balance and wellbeing

Equal Opportunity Employer

• We are an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Los Angeles and San Francisco Fair Chance Ordinance

• Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.