Workers Compensation Claims Adjuster III

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

📋 Description

• Conduct three-point contact on all new claims and apply enhanced scrutiny to complex, catastrophic, and high-exposure situations.

• Maintain thorough action plans with strategic resolution planning for assigned indemnity cases.

• Detect fraud indicators and refer cases to the Special Investigations Unit (SIU).

• Collect and document information on files involving multi-party liability, catastrophic injuries, significant subrogation opportunities, or unique legal issues.

• Oversee medical management for catastrophic and highly complex claims.

• Guide specialists, coordinate life care planners, oversee Utilization Review (UR) and Independent Medical Examinations (IMEs), and manage Permanent Total Disability (PTD) cases.

• Collaborate with case managers to optimize early Return to Work (RTW) outcomes.

• Review medical invoices for appropriateness concerning high-cost and atypical treatment modalities.

• Lead permanent disability evaluations on complex cases.

• Establish and modify reserves for high-exposure claims.

• Ensure status reports meet client reporting deadlines and adhere to specified formats.

• Manage the complete litigation process for complex files, including the selection of defense counsel, strategy development, expert retention, legal spending management, and trial preparation.

• Facilitate mediations, settlement discussions, and arbitrations.

• Make or suggest high-value settlement authority decisions in coordination with the Claims Supervisor and the client.

• Negotiate and finalize substantial settlements, including Compromise & Release (C&R) and Stipulated Awards.

• Oversee multi-lien resolutions and liaise with lien counsel and CMS.

• Pursue subrogation, multi-defendant contributions, and apportionment recoveries.

• Coordinate with recovery vendors and external subrogation counsel.

• Act as technical support for the Claims Supervisor.

• Provide guidance on complex decisions, reserve sufficiency, and escalated client matters.

• Mentor Adjuster I and II colleagues and contribute to unit-wide quality assessments.

• Serve as the primary point of contact for key client accounts.

• Cultivate relationships with clients and carriers.

• Maintain proactive, transparent communication with stakeholders and respond within required timelines.

⛳️ Requirements

• At least 7 years of workers' compensation claims experience, including a minimum of 5 years managing independent indemnity for complex, high-exposure, and litigated files; OR a Bachelor’s degree along with at least 5 years of independent-level WC indemnity experience; OR an equivalent combination.

• In-depth understanding of public entity liability claims, including Joint Powers Authorities (JPAs), self-insured programs, and pooled insurance arrangements.

• Active adjuster license in applicable states; Arizona is required; multi-state licensure is preferred.

• California Self-Insurance Plan (SIP) certificate is required for California claims.

• Extensive knowledge of applicable state workers' compensation statutes; mastery of California statutes is strongly preferred.

• Experience across multiple jurisdictions is highly valued.

• Direct experience with claims administration or processing platforms utilized in workers’ compensation and insurance claims handling.

• Proven track record of managing complex litigation through mediation, settlement conferences, and trial preparations.

• Advanced understanding of Permanent Disability (PD) ratings, Medicare Set Aside (MSA) requirements, and multi-party lien resolutions.

• Experience in managing catastrophic injuries and coordinating life care planning.

• Familiarity with claims management software.

• Proficient in Microsoft Office applications.

• Demonstrated capability to mentor junior adjusters and serve as a supervisory backup or senior technical resource.

• Strong skills in managing client relationships.

• Experience addressing escalated issues at a senior level.

• Professional designations such as AIC, ARM, WCCP, or CPCU are advantageous but not mandatory.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage.

• Company contributions to Health Savings Account (HSA) and Flexible Spending Account (FSA) plans.

• Employer-paid life and disability insurance.

• 401(k) plan with company matching contributions.

• Paid time off (PTO) and company-paid holidays.

• Employee assistance resources.

• Supportive culture that emphasizes balance and well-being.

• Complete benefits package.