Claims Adjuster, Workers Compensation

This is a fully remote position, open to applicants in California.

📋 Description

• Manage all elements of workers’ compensation claims autonomously, from initiation to final resolution.

• Perform prompt 3-point contact investigations and continue to gather information as case details evolve.

• Reduce claim exposure and make precise compensability decisions within legal guidelines.

• Establish and modify reserves within designated authority limits.

• Administer statutory medical and indemnity benefits throughout the duration of the claim.

• Adhere to relevant statutory guidelines, rules, and regulations.

• Oversee defense counsel, legal activities, associated fees, and costs during litigation.

• Focus on early resolution opportunities, assess exposure, and negotiate settlements effectively.

• Act as a liaison for partner agents and clients, offering claim guidance and outlining process expectations.

• Provide updates on claim status, verify coverage, deliver loss run reports, and ensure quality customer service.

• Collaborate with TPA adjusters and claims partners to enhance outcomes and customer satisfaction.

• Continuously seek improvements in claims operations, service quality, standard operating procedures (SOPs), and processes.

⛳️ Requirements

• A High School Diploma or equivalent is mandatory.

• A Bachelor's Degree or equivalent experience with some college coursework is desirable.

• At least 2 years of experience in workers’ compensation claims is necessary.

• Claims experience in California is required.

• Excellent communication skills, both written and verbal.

• Strong problem-solving abilities to manage intricate tasks and navigate solutions with minimal guidance.

• Familiarity with G-Suite Tools and collaboration platforms like Slack is preferred.

• Understanding of jurisdictional regulatory and statutory requirements along with CMS/MSA requirements.

• Proven knowledge and experience in claim adjudication, medical management, and litigation management.

• Capability to analyze and take appropriate actions in various focus areas based on multiple data points.

• Proficiency in conflict resolution to achieve favorable outcomes.

• Ability to make claims decisions that mitigate exposure while securing optimal results.

• Must reside and work within the United States, excluding territories.

• Must have access to reliable, high-speed internet.

🏝️ Benefits

• Competitive cash compensation

• Comprehensive health plans

• Generous PTO

• Future-focused 401k match

• Generous parental and caregiver leave

• Discretionary bonuses may be awarded to eligible team members