Worker's Compensation Adjuster, TPA

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

📋 Description

• Conduct investigations, evaluations, and adjustments of claims in line with established claims handling standards and legal requirements.

• Set reserves or offer reserve recommendations within the defined authority limits.

• Review, authorize, or oversee medical, legal, damage estimates, and other invoices.

• Negotiate disputed bills and invoices to achieve resolutions.

• Authorize and process claim payments through a designated claim payment system, adhering to established payment authority.

• Negotiate settlements in accordance with corporate guidelines, client directives, and state regulations.

• Select, refer, and supervise claim files assigned to external vendors.

• Review and manage personal claim diaries within the claims system.

• Evaluate and track subrogation claims to ensure resolution.

• Calculate disability rates in compliance with state laws.

• Facilitate timely communication with clients, claimants, and other relevant stakeholders.

• Provide notifications of qualifying claims to excess/reinsurance carriers.

• Adhere to corporate claims handling standards and specific client handling instructions.

• Manage a dedicated portfolio of California Workers’ Compensation claims from the investigation phase through to resolution.

⛳️ Requirements

• A minimum of 10 years of experience in handling California Workers’ Compensation claims, encompassing full claim investigation, evaluation, and resolution.

• Required Workers’ Compensation Designation: CAWCS, WCIRB, CPWC, or WCCA.

• Ability to respond effectively to the needs of internal and external clients.

• Strong analytical and negotiation skills.

• Excellent communication skills, both internally and externally.

• Proven track record in managing complex and litigated California claims.

• Understanding of responsibilities associated with lower-level claim positions.

• Visa sponsorship is not available.

• Bilingual proficiency in Spanish is highly valued but not mandatory.

• SIP designation is preferred but not essential.

• A Bachelor’s degree is preferred but not required.

🏝️ Benefits

• Four weeks of paid time off that accrues throughout the year according to company policy.

• Ten paid holidays during the first year.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Life insurance coverage.

• Disability insurance coverage.

• 401(k) retirement plan.

• Employee Stock Ownership Plan (ESOP).

• Opportunities for internal training and career advancement.

• A supportive, team-oriented work environment.

• Potential eligibility for bonuses or other forms of compensation.

• Reasonable accommodations available throughout the application and hiring process.