Casualty Claims Adjuster

SPECTRAFORCE; California; On-site; USD 80,000 - 99,000; Full time

Job summary

Spectraforce is seeking a Senior Workers Compensation Adjuster in California to manage moderate to high-value casualty claims with minimal supervision. The role requires advanced investigative and negotiation skills, collaboration with legal and technical experts, and a focus on compliant, efficient resolutions.

Responsibilities include leading investigations, reserve setting, and cross-functional coordination to achieve optimal outcomes.

Qualifications

• Bachelor’s degree preferred, or a combination of education and equivalent experience.
• 5–10+ years of workers compensation claims handling experience with an insurance carrier.
• Must possess or obtain and maintain appropriate state adjuster licenses and continuing education credits.
• Skilled in negotiating complex claims and developing strategies to influence outcomes.
• Ability to sit/stand for extended periods and work on-site as needed.

Responsibilities

• Independently manage moderate to complex, high-value casualty claims with thorough analysis and resolution.
• Lead investigations, assess coverage, and issue reservation of rights and coverage letters.
• Escalate issues as needed and coordinate with legal, underwriting, vendors, and agents.
• Identify opportunities to transfer risk and pursue subrogation; negotiate to optimize claim outcomes.
• Ensure claims activities comply with regulatory and company standards; maintain detailed records and reports.
• Set reserves, authorize payments, and make financial decisions within authority.
• Mentor junior claim handlers and contribute to training and best practices.

Education

Bachelor’s degree preferred or equivalent experience

Job description

Employment Type: Full-Time / Permanent

POSITION OVERVIEW:

The Senior Workers Compensation Adjuster is responsible for managing moderate to complex and high-value casualty claims with minimal supervision. This role requires advanced investigative and negotiation skills to effectively resolve disputes and handle escalated situations. The Consultant works closely with internal and external experts, including legal counsel and technical specialists, to ensure thorough claim evaluation and resolution.

Key responsibilities include representing the company in various forums related to claims litigation, maintaining a high standard of professionalism, and ensuring compliance with regulatory and company standards. The role demands strategic thinking, sound judgment, and the ability to navigate sensitive and high-impact claim scenarios.

• Responsibilities:Independently manage moderate to complex, high-value casualty claims, ensuring thorough analysis and resolution. Lead thorough investigations, assess coverage, and issue appropriate documentation including reservation of rights and coverage letters. Escalate issues as needed.
• Identify opportunities to transfer risk and pursue subrogation. Proactively resolve disputes, deescalate sensitive situations, and ensure optimal claim outcomes through strategic negotiation and litigation management.
• Ensure all claims activities comply with regulatory and company standards. Maintain accurate, detailed records and prepare comprehensive reports. Execute jurisdictional compliance requirements and support others in understanding regulatory obligations.
• Set reserves, authorize payments, and make financial decisions within authority. Demonstrate strong financial acumen and contribute to reserving accuracy and efficiency.
• Coordinate with internal and external stakeholders including legal, underwriting, vendors, and agents. Lead cross-functional meetings and communicate complex information clearly to diverse audiences.
• Use advanced tools and analytics to identify trends, correct inconsistencies, and improve claims handling efficiency. Ensure proper data ingestion, labeling, and protection of personally identifiable information (PII).
• Serve as a mentor to junior claim handlers, providing guidance on complex claims, compliance, and litigation processes. Support training initiatives and contribute to the development of best practices and educational materials.
• Qualification:Bachelor’s degree preferred, or a combination of education and equivalent experience.
• 5–10+ years of workers compensation claims handling experience with an insurance carrier.
• Must possess or obtain and maintain appropriate state adjuster licenses and continuing education credits.
• Skilled in negotiating complex claims and developing strategies to influence outcomes. Demonstrates sound judgment and decision-making on high-exposure cases, including litigation and compliance matters.
• Communicates clearly and effectively in both verbal and written formats across a variety of situations. Selects appropriate communication channels and consistently demonstrates empathy toward all stakeholders.
• Highly organized with the ability to manage complex workflows and participate in project work. Demonstrates strong time management and desk management skills, and mentors others in these areas.
• Possesses in-depth understanding of the regulatory environment and jurisdictional requirements. Handles complex compliance issues and mentors others on regulatory standards.
• Provides exceptional, empathetic customer service. Effectively manages escalated claims and sensitive customer concerns with professionalism and clarity.
• Ability to use a personal computer and other standard office equipment.
• Ability to sit and/or stand for extended periods.
• Required to work on-site as needed.
• Ability to travel as necessary.
• Ability to work in a fast paced, changing or stressful environment.
• Ability to perform work in a noisy/loud work environment.
• May be required to have and maintain sufficient home-based internet connection.
• For information on benefits, equal opportunity employment, and location-specific applicant notices

At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws.This position's pay range is $80000.00/Yearly - $99000.00/Yearly.