Job Description

California Workers Compensation Adjuster (Permanent)

Job Summary

Seeking a highly skilled and experienced Workers Compensation Claims Adjuster to join a team. This role involves managing all aspects of workers compensation claims, including determining compensability, verifying coverage, administering disability and medical benefits, negotiating claim resolutions, and providing exceptional service to injured employees, employers, and medical/legal professionals.

Compensation Package

• Medical, dental, and vision insurance
• Life insurance
• 401(K) with company match
• Opportunities for professional growth and development in a supportive and collaborative environment

Responsibilities

• Receive and manage newly reported claims
• Maintain and update claim notes throughout the lifespan of claims
• Record claim information in an electronic database
• Conduct interviews with claimants, insureds, medical professionals, and witnesses to determine claim validity
• Communicate claim compensability decisions to claimants, employers, and medical providers
• Set appropriate reserves based on the nature and extent of injuries
• Calculate lost time wages and administer disability payments
• Coordinate independent medical examinations and prepare relevant documentation
• Maintain regular correspondence with claimants, insureds, and nurse case managers
• Review and process medical bills through third-party vendors for additional discounts
• Collaborate with claimants and insureds to facilitate early return-to-work
• Partner with legal counsel to protect insured interests on litigated claims
• Attend settlement conferences, mediations, and hearings on behalf of the company or insured
• Review and approve defense attorney bills within authority
• Provide relevant loss information to underwriting and risk management teams
• Respond to state requests for health cost disputes, applications for hearings, and penalty assessment letters
• Identify subrogation opportunities and pursue recovery
• Lead claim reviews with clients as requested
• Perform other duties as assigned

Qualifications/Requirements

• Minimum of 10 years of experience adjusting Workers Compensation Claims in California
• SIP Certification is required
• Bilingual proficiency in Spanish and English is required
• Current with Continuing Education Units (CEUs)
• Proficiency in the Microsoft Office suite
• In-depth knowledge of California workers compensation laws
• Strong understanding of medical terminology and treatment progression
• Excellent oral and written communication skills
• Exceptional attention to detail and organizational abilities
• Proven negotiation skills for resolving issues and settlements
• Strong customer service orientation with a commitment to timely responses
• Adaptability to changing technologies and new systems
• Ability to establish and maintain effective working relationships with others

#LI-BR1