Workers Compensation, Claims Adjuster

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

📋 Description

• Evaluate mid- to senior-level workers' compensation claims to ascertain the benefits owed.

• Ensure the continuous adjudication of claims aligns with company standards and industry best practices.

• Identify opportunities for subrogation of claims and facilitate negotiations for settlements.

• Oversee workers' compensation claims, assessing compensability and benefits for long-term indemnity claims.

• Monitor the accuracy of reserves and file the necessary documentation with the state agency.

• Create and manage claims action plans until resolution is achieved.

• Coordinate return-to-work initiatives and authorize claim payments.

• Approve and process assigned claims while managing action plans in accordance with claims or client contracts.

• Communicate claim activities to claimants and clients.

• Ensure claim files are accurately documented and claims coding is correct.

• Process intricate lifetime medical and/or defined-period medical claims as applicable.

• Maintain professional relationships with clients.

• Support quality initiatives and perform other designated responsibilities.

• Travel as necessary.

⛳️ Requirements

• Candidates must be residents of California.

• A minimum of four (4) years of experience in California Workers' Compensation claims management or an equivalent combination of education and experience is required.

• Knowledge of California jurisdiction is essential.

• SIP certification is required or must be obtained within one (1) year of employment.

• A bachelor's degree from an accredited college or university is preferred.

• Proficient in analyzing claims and determining benefits owed.

• Capable of managing multiple priorities while meeting deadlines.

• Possess clear and conceptual thinking skills.

• Demonstrate excellent judgment, troubleshooting, problem-solving, analytical skills, and discretion.

• Ability to manage work-related stress effectively.

• Proficient in computer keyboarding.

• Capable of hearing, vision, and verbal communication.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and promotional growth.

• Medical, dental, and vision insurance.

• 401K with matching contributions starting on day one.

• Paid Time Off (PTO).

• Disability and life insurance.

• Employee assistance program.

• Flexible spending or health savings account.

• Additional voluntary benefits available.