Claims Adjuster | California

Job Brief

Remote Opportunity!

Claims Adjuster (Worker’s Compensation)- California | 100% Remote Opportunity - West Coast Hours (M-F 8am-5pm PST / M-F 11am-8pm EST)

Preference given to those with workers’ compensation claims experience in California

General Summary:

The Claims Adjuster performs duties to manage a caseload of low to moderately complex workers’ compensation claims. This consists of determining compensability, setting reserves, and approving payments, in accordance with industry/company Claims Best Practices. Analyzes and interprets statutes and regulations applicable to case facts in order to render appropriate legal and ethical decisions. Analyzes legal issues and directs legal strategy. Manages claims in a prompt and thorough manner from inception through closure. Aggressively negotiates the settlement of claims.

Essential Duties and Responsibilities:

• Active California Worker's Comp certification is strongly preferred.
• Must have a Minimum of 2 years’ experience working in a worker's compensation claims environment at the Adjuster level managing lost time claims.
• With general management oversight, works within assigned authority limits on claims reflecting a low to moderate degree of technical complexity and severity.
• Analyzes case facts, applies appropriate statutes and regulations and identifies possible fraud and abuse, in determining compensability.
• Analyzes case facts to establish timely and accurate case reserves. Requires knowledge of medical disabilities and related costs, as well as judgment of extent of disability. Applies knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost.
• Completes detailed settlement analysis and recommends appropriate settlement value, utilizing 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 Social Security and Medicare application procedure as applicable.
• Ensures quality medical management by applying appropriate medical concepts, and by interpreting and applying appropriate statutes and regulations. Requires independent judgment to render accurate decisions.
• Proactively manages claim litigation process. Manages legal issues that can be adjudicated without the use of a defense attorney. Directs legal strategy and participates in preparation of the case for litigation. Provides testimony at hearings as needed.
• Analyze physician reports for content and accuracy to ensure prompt and appropriate processing of medical and indemnity benefits.
• Evaluates, prepares, and manages cases of possible permanent partial disability.
• Manages dedicated accounts as assigned. Participates in telephonic claim reviews.
• Other duties may be assigned.

Job Requirements:

• Excellent written and oral communication, listening, interpersonal, customer service and telephone skills
• Proficient in the use and knowledge of MS Office software, with the ability to type at a minimum of 35 wpm.
• 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. Comprehensive knowledge of AMA Guides to the Evaluation of Permanent Impairment and medical terminology.
• Self-motivated with excellent analytical, problem solving and decision-making skills and ability to deal professionally with people in stressful situations. Ability to maintain confidentiality. Conduct business at all times with the highest standards of personal, professional and ethical conduct.
• If State Certification is required, must meet requirements and obtain certification within state mandated time frame.
• Must have High School Diploma or GED equivalent.
• Must possess 2-5 years of related claims experience.
• Ability to participate in job related internal and external training and pass any tests within the set guidelines.
• Bachelor’s degree or equivalent business experience preferred.
• WCCP certification preferred.
• Current Experienced Claims Adjuster Designation preferred.
• Working knowledge of an imaged claims environment preferred.
• Bilingual in English and Spanish preferred.

An equivalent combination of education and experience may be substituted for the requirements listed above.

Salary Range: $48,000 - $77,000 + comprehensive benefits package. Please follow the link to our benefits page for details! https://www.employers.com/careers/our-benefits-and-perks/

Work Environment:

• Remote: This role is remote, and only open to candidates currently located in the United States and able to work without sponsorship.
• It requires a suitable space 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

EMPLOYERS is a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work!

We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS®!

Headquartered in Reno, Nevada, EMPLOYERS/ attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS/ is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees.

We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other!

At EMPLOYERS, you’ll discover an energetic environment that inspires top achievement. As “America’s small business insurance specialist”, we have the resources, a solid reputation, and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote HP22