Senior Claims Adjuster – Worker's Compensation

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

📋 Description

• Manage all facets of workers’ compensation claims independently, from initiation to closure.

• Assess and oversee high-value, high-risk, and intricate claims.

• Execute timely three-point contact investigations and continue to probe as case details evolve.

• Mitigate complex risks while striving for optimal outcomes.

• Make timely and precise compensability determinations in accordance with statutory requirements.

• Establish and modify reserves within defined authority limits.

• Present claims to senior management and both internal and external stakeholders.

• Administer statutory medical and indemnity benefits throughout the claims process.

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

• Oversee legal proceedings with defense counsel, managing legal fees and expenses effectively.

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

• Assist partner agents and clients with claim guidance and process expectations.

• Provide updates on claim status, coverage verification, and loss run reports.

• Enhance claims operations, service processes, standard operating procedures (SOPs), protocols, and methodologies.

⛳️ Requirements

• A High School Diploma or equivalent is mandatory.

• A minimum of 5 years of experience in workers’ compensation claim adjusting is required.

• Experience handling California workers’ compensation claims is essential.

• Active licensing in relevant states is required.

• Capacity to evaluate and identify high-value, high-risk, and complex claims.

• Excellent communication skills, both written and verbal.

• Strong problem-solving abilities to manage complex tasks with minimal supervision.

• Advanced knowledge of regulatory and statutory requirements at the jurisdictional level, along with CMS/MSA requirements.

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

• Advanced analytical skills to make informed decisions based on multiple data points.

• Ability to make claim decisions that mitigate risks while achieving optimal outcomes.

• Proficiency in conflict resolution to achieve favorable results.

• Capability to mentor less experienced adjusters.

• Familiarity with G-Suite tools and collaboration platforms such as Slack is preferred.

🏝️ Benefits

• Competitive cash compensation

• Comprehensive health plans

• Generous PTO

• Future-focused 401k match

• Generous parental and caregiver leave

• Discretionary bonuses may be awarded annually to eligible team members