Charles Taylor · 9 hours ago

Workers' Compensation Claims Adjuster - Remote Southern CA

Long Beach, CA

Full-time

Remote

Mid Level

$90K/yr - $115K/yr

3+ years exp

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Responsibilities

Receives newly reported claims

Maintains and updates claim notes throughout lifespan of claim

Records claim information in electronic database

Interviews claimants, insureds, medical professionals and witnesses to determine claim validity

Communicates claim compensability decisions to claimant, employer and medical provider

Sets appropriate reserves based on nature/extent of injury

Calculates lost time wages, makes disability payments directly to claimants and diaries future payments as appropriate

Orders independent medical examination as necessary and prepares all relevant documentation for physician review

Maintains regular correspondence with claimants, insureds, and nurse case manager to include claim updates, medical appointments, or issues with disability payments.

Reviews and processes medical bills through third-party vendor for additional discount opportunities

Aggressively collaborates with claimants and insureds to ensure early return-to-work is pursued

Works in partnership with legal counsel to warrant that insured’s interests are protected on litigated claims which includes providing all relevant claim documentation needed for defense counsel to successfully defend claim and evaluate ultimate claim exposure

Attends settlement conferences, mediations, and hearings on behalf of the insurance company/insured

Reviews and approves defense attorney bills within authority

Works with underwriting to help provide relevant information on losses for renewal rates as well as Risk Management to identify trends and may interact with agents for insureds on losses

Responds to State requests for health cost disputes, applications for hearings and penalty assessment letters

Identifies subrogation potential and pursues recovery

Leads claim reviews with clients as requested

Other duties as assigned

Qualification

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Workers Compensation Claims AdjustingBilingual in SpanishMicrosoft Office SuiteWorkers compensation lawsMedical terminologyCustomer service focusAdaptability to technology