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EMPLOYERS · 21 hours ago

Claims Adjuster II | California

United States

Full-time

Remote

Entry, Mid Level

$50K/yr - $75K/yr

2+ years exp

EMPLOYERS is a dynamic provider of workers' compensation insurance and services. They are seeking a Workers’ Compensation Claims Adjuster II who will be responsible for the timely and accurate management of claims, customer service, and coordinating medical treatment while mitigating legal exposure.

FinanceFinancial ServicesInsurance

No H1B

Responsibilities

Completes initial contacts to obtain necessary additional information, verify coverage, determine compensability and develop of plan of action. Completes and maintains accurate claim system data as it pertains to work comp insurance claims

Analyzes case facts to establish timely and accurate case reserves using knowledge of medical disabilities and related costs, as well as judgment of extent of disability

Provides timely and appropriate customer service within established best practices. Maintains ongoing professional communications with all internal and external customers

Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines. Files appropriate state forms, as needed

Proactively coordinates and monitors medical treatment to continue to move the claim forward. Uses resources, internal and external, to contain costs and manage exposure

Reviews and analyzes legal exposures. Collaborates with defense attorneys to manage legal issues. Proactively mitigates exposure to litigation, prices up claims for settlement and works within authority to resolve claims

Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure

Other duties as assigned

Qualification

Workers' compensation claims adjustingWorkers' compensation lawsAnalytical skillsCustomer service skillsInsurance certifications WCCPInsurance certifications AICInsurance certifications ARMInsurance certifications CPCUMulti-taskingPrioritizationCommunication skillsProblem solving skillsDecision-making skills

Required

2 - 5 years' work comp claims adjusting or insurance experience

Excellent communication and customer service skills and knowledge of an imaged environment

Demonstrated knowledge of workers' compensation laws and ability to adhere to statutes, regulations and company policies and practices, as well as related claim management procedures/protocols

Self-motivated with excellent analytical, problem solving and decision-making skills. Strong ability to multi-task and prioritize

High school diploma or equivalent required

Equivalent combinations of education and experience may be considered

If state certification or license is required, must meet requirements and obtain certification within state mandated timeframe and maintain any required license through continuing education