EMPLOYERS ยท 5 hours ago
Senior Claims Adjuster I | California
United States
Full-time
Remote
Mid, Senior Level
$60K/yr - $95K/yrEMPLOYERS is a dynamic, fast-growing provider of workers' compensation insurance and services. The Senior Claims Adjuster I is responsible for the timely and accurate management of workers' compensation claims in California, including handling benefits, addressing litigation, and managing exposure cases.
FinanceFinancial ServicesInsurance
No H1B
Responsibilities
Completes initial contacts to obtain necessary information, verify coverage, determine compensability and develop a plan of action
Completes and maintains work comp claim data integrity
Independently analyzes workers' compensation 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 work comp Corporate Claims to proactively evaluate and mitigate high exposure losses
Provides timely and appropriate customer service within established best practices
Maintains ongoing professional communications with all internal and external customers
Accurately evaluates and pays workers' compensation benefits in compliance with statutory and company procedures and guidelines
Files appropriate (California) work comp state forms, as needed
Proactively manages or coordinates medical treatment to continue to move the claim forward. Uses internal and external resources to contain costs and manage exposure
Reviews and analyzes litigation and legal issues as it pertains to California Workers' Compensation claims
Directs legal strategy and participates in preparation of the case for litigation
Collaborates with defense attorney to move work comp claims to resolution
Completes detailed settlement analysis and recommends appropriate settlement value, utilizing in-depth knowledge of appropriate 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
Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure
Uses a high degree of independent judgment to render accurate decisions
Mentors other team members and acts as a Subject Matter Expert for legal, jurisdiction and Company needs
Other duties as assigned
Qualification
Required
Experience adjusting CALIFORNIA work comp claims
Ability to work West Coast hours (M-F 8am-5pm PST)
Timely and accurate management of workers' compensation claims in California
Handling medical and indemnity benefits
Addressing litigation and complex issues
Managing moderate to high exposure cases
Completing initial contacts to obtain necessary information
Verifying coverage and determining compensability
Developing a plan of action
Maintaining work comp claim data integrity
Independently analyzing workers' compensation case facts
Establishing timely and accurate reserves
Collaborating with work comp Corporate Claims
Providing timely and appropriate customer service
Maintaining ongoing professional communications with all internal and external customers
Accurately evaluating and paying workers' compensation benefits
Filing appropriate (California) work comp state forms
Proactively managing or coordinating medical treatment
Reviewing and analyzing litigation and legal issues
Directing legal strategy and participating in preparation of the case for litigation
Collaborating with defense attorney to move work comp claims to resolution
Completing detailed settlement analysis and recommending appropriate settlement value
Regularly reviewing caseload and proactively taking action to guide claims to closure
Using a high degree of independent judgment to render accurate decisions
Mentoring other team members and acting as a Subject Matter Expert
Preferred
WCCP, AIC, ARM, CPCU or other insurance designation
Bachelor's degree or equivalent business experience
Benefits
Comprehensive benefits package
Company
EMPLOYERS
Employers is a provider of workers' compensation insurance for small businesses.
Founded in 1913
501-1000 employees
Funding
Current Stage
Public CompanyTotal Funding
unknown2007-01-31IPO
Leadership Team
Mark Law
VP, Digital Products and Innovation
Michael Gill
AI and Data Product Executive, Chief Data Analytics Officer
Recent News
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