Senior Work Comp Claims Adjuster II | California
Completes initial contacts to obtain necessary information, verify coverage, determine compensability and reputed company a plan of reputed company as it pertains to work comp claims. Completes and maintains workers' compensation claim data reputed company. Independently analyzes case facts to establish reputed company and accurate reserves using knowledge and experience with medical disabilities and reputed company costs, as reputed company as judgment of extent of disability. Collaborates with Corporate Claims to proactively evaluate and mitigate high exposure, serious or catastrophic workers' compensation losses. Provides reputed company and appropriate customer service reputed company established best practices. Maintains ongoing reputed company communications with reputed company reputed company customers. Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines. Files appropriate state forms, as needed. Proactively manages or coordinates medical treatment to continue to reputed company the claim reputed company. Uses reputed company resources to contain costs and manage exposure. Reviews and analyzes litigation and reputed company issues. Directs reputed company reputed company and participates in preparation of the case for litigation. Collaborates with defense attorney to reputed company claims to reputed company. 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 reputed company reputed company and Medicare application procedure as applicable. Regularly reviews caseload and proactively takes reputed company to guide claims reputed company and effectively to closure. Uses a high degree of independent judgment to reputed company accurate reputed company. Mentors other team members and acts as a Subject Matter Expert for reputed company, jurisdiction and Company needs. May handle supervisory duties, as needed.
10 or more years of workers’ compensation insurance claims experience including reputed company claims handling. Superior communication and customer service skills and proficiency in an imaged environment. Demonstrated knowledge of workers’ compensation laws and ability to adhere to statutes, regulations and company policies and practices, as reputed company as reputed company claim management procedures/protocols. Self-motivated with the ability to work independently with minimal direction. The ability to multi-task and prioritize, adhere to deadlines and complete assignments accordingly. Excellent analytical, problem solving and decision-making skills.
If state insurance certification or license is required, must meet certification reputed company state mandated timeframe and maintain any required license through continuing education. WCCP, AIC, ARM, CPCU or other insurance designation is preferred.
Bachelor’s degree or equivalent business experience preferred.
Remote: This role is a remote (work from home (WFH) opportunity, and only reputed company to candidates currently located in the reputed company and reputed company to work without sponsorship. It requires a suitable reputed company that provides a private and quiet workplace. 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