Senior Workers Compensation Claims Adjuster

Sr. Workers Compensation Adjuster - California

Reports to : Team Lead

Overview :

The Workers’ Compensation Claims Adjuster must be knowledgeable of the California Labor Code and administration of claims.

It is the responsibility of a Workers' Compensation Claims Adjuster to receive and organize all documents related to the employee and the injury to make a determination regarding the claim.

The Claims Adjuster is responsible for the prompt and efficient examination and investigation of claims. Workers' Compensation Claims Adjusters abide by company guidelines when making claim determinations.

This role requires excellent communication and customer service skills, strong motivation and organizational skills.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Responsibilities :

• Assess coverage and review claims for purposes of investigations, action plans, evaluation, fraud, and claim resolution.
• Complete quality investigations by gathering pertinent information. Reviews and evaluates coverage and / or liability. Secures necessary information (i.

e., reports, policies, releases, statements, or other documents) in the investigation of claims.

• Conduct a thorough analysis of liability and continually assess exposure and evaluate for accurate reserves.
• Works toward the resolution of claims files and takes full charge of claim from inception to resolution.
• Will affect settlements / reserves within prescribed limits and submits recommendations to supervisor on cases exceeding personal authority.
• Ensures that claims payments calculated accurately and are issued in a timely and accurate manner.
• Ensures compliance of claims handling pursuant to all state, legal, statutory, and regulatory bodies to comply with all company procedures and requirements.
• Maintains a diary to follow claim progress on all claims.
• Determine liability for permanent disability, mitigation of costs and resolution of claim.
• Oversee litigation and coordination of claim with defense team.

Qualifications :

• 5 years plus experience handling workers’ compensation claims.
• Current California Adjuster Certification.
• Familiarity with state workers’ compensation laws and regulations
• Candidates will be required to have strong skills in customer service, verbal and written communications, time management, and organizational skills.
• Excellent attention to detail.
• Must demonstrate an ability to work independently.
• Must demonstrate a strong knowledge of computers and software.

Communication Skills :

• Demonstrated ability to manage relationships in a fast-paced environment along with problem solving and decision-making skills to work through a variety of challenging situations.
• Ability to respond to requests effectively and efficiently.
• Listens effectively and clearly expresses ideas and recommendations.
• Proficient in communicating effectively and clearly, both orally and in writing.
• Capable of carrying out detailed written or verbal instructions.

Technical Expertise :

• Complete understanding of all Microsoft Office applications.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Proficient in the operation of computer equipment and applications.

Customer Service :

• Responds timely and consistently with all communication.
• Builds credibility with internal and external customer.
• Creates customer satisfaction.
• Familiar with the company tools and is comfortable reviewing with all levels of management in a professional manner.

Work Environment / Hours

• This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
• Team Environment
• Verbal Contact with Others
• Standard Work Hours : Mon-Fri, 8 : 30a-5p(37.5 Hours per week) Additional hours will be worked based on business needs.

Adjustment from 8 : 30a-5pm per arrangement with Management.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is required to frequently sit;

work using a computer; interact with customers (by phone and / or email); use hands to finger, handle or feel; and reach with hands and arms.

Travel

Minimal travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.

Duties, responsibilities, and activities may change at any time with or without notice.

Equal Opportunity Employer, M / F / D / V