California - Sr. Workers Compensation Adjuster

Job Summary :

The Senior Workers Compensation Adjuster is responsible for managing and resolving complex workers compensation claims from inception to conclusion.

This role involves thorough investigation, evaluation, and settlement of claims in compliance with state regulations and company policies.

The ideal candidate will possess in-depth knowledge of workers compensation laws and demonstrate exceptional analytical and negotiation skills.

Key Responsibilities :

Claim Management :

• Handle a caseload of complex workers compensation claims, ensuring timely and accurate processing.
• Conduct detailed investigations to gather necessary information, including claimant interviews, witness statements, and medical records.
• Evaluate claims to determine compensability, liability, and appropriate reserves.

Compliance and Documentation :

• Ensure compliance with state regulations, company policies, and industry standards throughout the claims process.
• Prepare and maintain comprehensive and accurate documentation for each claim.
• Submit required reports to regulatory agencies and internal stakeholders promptly.

Medical and Legal Coordination :

• Coordinate medical care and treatment plans for claimants, including referrals to medical professionals and review of medical reports.
• Work closely with legal counsel to manage litigated claims and represent the company at hearings and mediations as needed.

Customer Service :

• Provide excellent customer service to claimants, employers, and other stakeholders by responding promptly and professionally to inquiries.
• Educate claimants and employers on the workers compensation process and benefits.

Settlement and Negotiation :

• Develop and implement strategies for claim resolution, including negotiation of settlements within authority limits.
• Recommend settlements exceeding authority limits to management with thorough documentation and rationale.

Qualifications :

• Education : Bachelor’s degree in Business Administration, Insurance, Risk Management, or a related field preferred.
• Experience : Minimum of 5-7 years of experience in workers compensation claims adjusting, with a proven track record of handling complex claims.
• Certification : Professional designations such as Workers' Compensation Professional (WCP) or Certified Workers' Compensation Claims Professional (CWCP) are highly desirable.
• Skills :
• Strong knowledge of workers compensation laws and regulations.
• Excellent analytical, organizational, and decision-making skills.
• Effective negotiation and conflict resolution abilities.
• Proficiency in claims management software and Microsoft Office Suite.
• Superior written and verbal communication skills.
16 days ago