What are the responsibilities and job description for the Senior Claims Ajuster position at Employers?

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

General Summary

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

The position requires working West Coast hours (M-F 8am-5pm PST) and experience adjusting CALIFORNIA work comp claims.

Essential Duties and Responsibilities

Analyzes case facts to establish timely and accurate reserves using knowledge and experience with medical disabilities and related costs, as well as judgment of extent of disability.
Collaborates with Corporate Claims to proactively evaluate and mitigate high exposure losses.
Provides timely and appropriate customer service within established best practices, maintaining ongoing professional communications with all internal and external customers.
Evaluates and pays benefits in compliance with statutory and company procedures and guidelines, filing appropriate state forms as needed.
Manages or coordinates medical treatment to continue moving the claim forward, using internal and external resources to contain costs and manage exposure.
Reviews and analyzes litigation and legal issues, directing legal strategy and participating in preparation of the case for litigation.
Completes detailed settlement analysis and recommends appropriate settlement value, utilizing in-depth knowledge of workers' compensation insurance principles and laws.
Mentors other team members and acts as a Subject Matter Expert for legal, jurisdiction and Company needs.

Requirements

7 or more years of related claims experience including complex claim handling, preferably in CALIFORNIA workers' compensation.

Superior communication and customer service skills, proficiency in an imaged environment.

Demonstrated knowledge of workers' compensation laws and ability to adhere to statutes, regulations and company policies and practices.

Self-motivated with the ability to work independently with minimal direction, multi-tasking, prioritizing, adhering to deadlines, and completing assignments accordingly.

Certification

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

Education

Bachelor's degree or equivalent business experience preferred.

Work Environment :

Remote : This role is a remote opportunity, open to candidates currently located in the United States and able to work without sponsorship.

Expected Work Hours : Schedules are set to accommodate the requirements of the position and the needs of the organization, which may be adjusted as needed.

Travel : May be required to travel to off-site location(s) to attend meetings as necessary.

This position offers a salary range of $60,000-$85,000 and a comprehensive benefits package. Please follow the link to our benefits page for details.

Salary : $60,000 - $85,000

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