Senior Claims Ajuster

Senior Claims Adjuster I - California | 100% Remote (WFH)

General Summary

The Senior Claims Adjuster I role involves the timely and accurate management of workers' compensation claims with minimal oversight. This includes handling medical and indemnity benefits, addressing litigation and complex issues, and managing moderate to high exposure cases.

Must work West Coast hours (M-F 8am-5pm PST) and have experience adjusting CALIFORNIA work comp claims.

Essential Duties and Responsibilities

• Initial contacts are made to obtain necessary information, verify coverage, determine compensability, and develop a plan of action. Claim data integrity is maintained.
• Cases are independently analyzed to establish timely and accurate reserves using knowledge and experience with medical disabilities and related costs, as well as judgment of extent of disability.
• Collaboration with Corporate Claims is done to proactively evaluate and mitigate high exposure losses.
• Timely and appropriate customer service is provided within established best practices. Ongoing professional communications are maintained with all internal and external customers.
• Benefits are accurately evaluated and paid in compliance with statutory and company procedures and guidelines. Appropriate state forms are filed, as needed.
• Medical treatment is proactively managed or coordinated to continue moving the claim forward. Internal and external resources are used to contain costs and manage exposure.
• Litigation and legal issues are reviewed and analyzed. Legal strategy is directed, and the case is prepared for litigation. Collaboration with defense attorney is done to move claims to resolution.
• Detailed settlement analysis is completed, and appropriate settlement value is recommended. In-depth knowledge of workers' compensation insurance principles and laws, subrogation recoveries, offsets and deductions, claim and disability duration, cost containment principles; including medical management practices and Social Security and Medicare application procedure as applicable, is utilized.
• Caseload is regularly reviewed, and proactive action is taken to guide claims efficiently and effectively to closure. A high degree of independent judgment is used to render accurate decisions.
• Others are mentored, and subject matter expertise is provided for legal, jurisdiction, and Company needs.
• Other duties as assigned.

Requirements

• 7 or more years of related claims experience, including complex claim handling. Internal candidates with proven results may also qualify.
• Superior communication and customer service skills and proficiency in an imaged environment.
• Demonstrated knowledge of workers' compensation laws and ability to adhere to statutes, regulations, and company policies and practices, as well as related claim management procedures/protocols.
• Self-motivated with the ability to work independently with minimal direction. The ability to multi-task and prioritize, adhere to deadlines, and complete assignments accordingly.
• Excellent analytical, problem-solving, and decision-making skills.
• Equivalent combinations of education and experience may be considered.

Certification

• WCCP, AIC, ARM, CPCU, or other insurance designation preferred.

Education

• Bachelor's degree or equivalent business experience preferred.

Work Environment:

• This role is a remote (work from home (WFH)) opportunity, open to candidates currently located in the United States and able to work without sponsorship.
• A suitable space that provides a private and quiet workplace is required.
• Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
• Travel: May be required to travel to off-site location(s) to attend meetings, as necessary.

This is a salary-range-based role, with a comprehensive benefits package available. Details on our benefits can be found here.

About EMPLOYERS

EMPLOYERS is a dynamic and fast-growing provider of workers' compensation insurance and services. We're seeking a goal-oriented individual who is willing to put their ideas to work.

We offer a positive, challenging work environment combined with an opportunity to build your career as you help us grow our business in innovative and imaginative ways that are uniquely EMPLOYERS.

Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource: employees across the United States. We're known for the quality service and expertise we provide to our clients, as well as the exemplary work environment we provide for our employees.

We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These pillars support how we do business with our clients and how we treat each other.

At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As 'America's small business insurance specialist', we have the resources, a solid reputation, and an expanding nationwide identity to enrich your work/life and enhance your career.