Worker's Claims Adjuster II

Worker's Compensation Claims Adjuster II

Join to apply for the Worker's Compensation Claims Adjuster II role at Inter Med Cost Containment Services
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Reports directly to the unit Claims Supervisor. In accordance with applicable statutes and in keeping with company rules, regulations, and established performance objectives, this position is responsible for effectively managing to conclusion an assigned inventory of claim files.

• Perform a three‑point contact on all new losses within 24 hours of receipt of the claim to include the claimant, employer, and treating physician; document relevant facts surrounding the incident, disability, and treatment status.
• Thoroughly and accurately gather evidence regarding ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, vendor use, medical and expense payments, and the reason the claim remains open.
• Assure that all assigned indemnity claims have an up‑to‑date plan of action outlining activities and anticipated actions ultimately resolving the claim.
• Form a partnership with the medical case manager to maximize early return‑to‑work potential, thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claim costs.
• Initiate the referral to the SIU for cases with suspected fraud.
• Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when pre‑existing disability exists.
• Ensure that the claim file is handled in accordance with applicable statutes, in‑force service contracts, and company guidelines.
• Review and approve all vocational rehabilitation plans.
• Establish, monitor, and adjust monetary case reserves when warranted, in strict accordance with assigned authority levels.
• Review all medical bills for appropriateness prior to referral to Inter Med for payment and posting to the claim file.
• Maintain a courteous and helpful attitude, projecting a professional image on behalf of the company.
• Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt.
• Require a working knowledge of the Labor Code of the State of California as it pertains to workers’ compensation claims and the legal requirements for handling them.
• Litigation Management – direct, manage, and control the litigation process.
• Handle other duties and tasks as deemed appropriate by the Supervisor or Manager.

• Problem Solving – identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; uses reason even when dealing with emotional topics.
• Customer Service – manages difficult or emotional customer situations; responds promptly to customer needs; meets commitments.
• Interpersonal – focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others' ideas and tries new things.
• Team Work – supports everyone's efforts to succeed.

Bachelor’s degree (B.A.) from a four‑year college or equivalent, or 3–5 years of related experience and training, or 5 years without a SIP certificate, or an equivalent combination of education and experience.

We’re an equal‑opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.

Job Type: Full‑time

Seniority Level: Mid‑Senior level

Employment Type: Full‑time

Job Function: Human Resources

Industry: Insurance

$40.86 – $43.02 per hour