Workers Compensation Claims Adjuster II

About the role

Responsible for effectively managing to conclusion an assigned inventory or claims files in accordance with applicable statutes and in keeping with company rules, regulations, and established performance objectives under direction of the unit Claims Supervisor.

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 gather evidence regarding ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and the reason the claim is still open.
• 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.
• Exhibit and maintain a courteous and helpful attitude and project a professional image on behalf of the company.
• Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt.

Qualifications

• To perform the job successfully, an individual should demonstrate the following competencies: Problem Solving - Identifies and resolves problems in a timely manner; Gather and analyze information skillfully; Develop alternative solutions; Use reason even when dealing with emotional topics.
• Customer Service - Manage difficult or emotional customer situations; Respond promptly to customer needs; Respond to requests for service and assistance; Meet commitments.
• Interpersonal - Focus on solving conflict, not blaming; Maintain confidentiality; Listen to others without interrupting; Keep emotions under control; Remain open to others' ideas and try new things.
• Team Work - Support everyone's efforts to succeed.

Requirements

• Competency: To perform the job successfully, an individual should demonstrate the following competencies: Problem Solving - Identifies and resolves problems in a timely manner; Gather and analyze information skillfully; Develop alternative solutions; Use reason even when dealing with emotional topics.
• Customer Service - Manage difficult or emotional customer situations; Respond promptly to customer needs; Respond to requests for service and assistance; Meet commitments.
• Interpersonal - Focus on solving conflict, not blaming; Maintain confidentiality; Listen to others without interrupting; Keep emotions under control; Remain open to others' ideas and try new things.
• Team Work - Support everyone's efforts to succeed.

Qualification Requirements

• To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/or Experience

• Bachelor’s degree (B. A.) or equivalent; 3-5 years related experience & training with SIP certificate; 5 years without a SIP certificate; OR OREquivalent combination of education and experience.

Salary Range

• $32.60 - $43.30

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

• We will consider for employment qualified applicants with arrest or conviction records.