Senior Workers Compensation Claims Adjuster

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

📋 Description

• Manage moderate to complex, high-value casualty claims independently, ensuring a comprehensive analysis and resolution.

• Conduct thorough investigations, evaluate coverage, and produce necessary documentation, including reservation of rights and coverage letters.

• Spot opportunities for risk transfer and pursue subrogation efforts.

• Resolve disputes proactively, deescalate sensitive situations, and achieve optimal claim outcomes through effective negotiation and litigation management.

• Ensure all claims activities adhere to regulatory and company standards.

• Keep precise, detailed records and prepare extensive reports.

• Implement jurisdictional compliance requirements and assist others in understanding regulatory obligations.

• Set reserves, authorize payments, and make financial decisions within designated authority.

• Collaborate with internal and external stakeholders, including legal, underwriting, vendors, and agents.

• Facilitate cross-functional meetings and convey complex information clearly to varied audiences.

• Leverage advanced tools and analytics to identify trends, rectify inconsistencies, and enhance claims handling efficiency.

• Mentor junior claim handlers, offering guidance on complex claims, compliance, and litigation processes.

• Provide empathetic and clear communication throughout the claims process.

⛳️ Requirements

• Bachelor’s degree preferred, or a combination of education and relevant experience.

• Generally requires 5–10 years of experience in claims handling.

• Must hold or obtain and maintain the appropriate state adjuster licenses and continuing education credits.

• Proficient in negotiating complex claims and devising strategies to influence outcomes.

• Communicates clearly and effectively in both verbal and written forms across various situations.

• Maintains comprehensive and organized claim records, preparing detailed reports that summarize findings and recommendations.

• Highly organized with the ability to manage intricate workflows and participate in project work.

• Makes informed decisions based on thorough analysis of complex issues.

• Highly skilled in investigating complex cases and collaborating with both internal and external experts.

• Possesses a comprehensive understanding of the regulatory environment and jurisdictional requirements.

• Offers exceptional, empathetic customer service.

🏝️ Benefits

• Capability to use a personal computer and other standard office equipment.

• Ability to sit and/or stand for extended periods.

• Willingness to travel as needed.