Sr. Workers' Claims Adjuster

Overview

This position will be a remote position.

Must have a California SIP (Workers Compensation - Sr. Work Comp Claims Adjuster)
Must be Bilingual (English/Spanish)

Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

• Effectively manages a caseload of 130 to 140 workers’ compensation files, including very complex claims.
• Initiates and conducts investigation in a timely manner.
• Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel. Directs and manages as appropriate.
• Communicates with claimants, providers and vendors regarding claims issues.
• Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.
• Settles and/or finalize all claims and obtains authority as designated.
• Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
• Adheres to all Company policies and procedures.
• Conducts file reviews independently.
• Other duties as assigned.

Essential job function.

Computer, fax machine, copier, printer, and other office equipment.

Education/

Experience:

Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).

• Certifications and/or licenses as required by State regulation.

• Medical, Dental, Vision, Disability & Life Insurance
• 401(k) plan
• Paid time off
• Paid holidays