Job Description

Workers' Compensation Claims Adjuster II - California | 100% Remote Opportunity

The Work comp Claims Adjuster II is responsible for timely and accurate management of workers' compensation claims with moderate medical and indemnity benefit exposure, including litigation.

This opportunity will require working west coast hours (M-F 8am-5pm PDT)

Essential Duties and 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.

Requirements

• 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.

Certification

• 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.
• WCCP, AIC, ARM, CPCU or other insurance certification preferred.

Education

• Bachelor's degree or equivalent business experience preferred.

Work Environment

• Remote: This role is a remote (work from home (WFH) opportunity) and only open to candidates currently located in the United States and able to work without sponsorship.
• Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
• Travel: May be required to travel to off-site location(s) to attend meetings, as necessary

Salary Range: $60,000-$85,000 and a strong comprehensive benefits package.

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