Claims Adjuster II

EPITEC; Brea (CA); Hybrid; USD 62,000 - 69,000; Full time

Benefits offered by this job

Hybrid work environment

Job summary

EPITEC in California seeks an experienced Workers' Compensation Claims Adjuster II to manage claims from investigation through resolution. The role is based in Brea with a hybrid work schedule and a contract that may convert to full-time for the right candidate.

The ideal candidate has at least 3 years of WC claims handling, California license, strong negotiation and analytical skills, and proficiency with CMS and MS Office. This is a carrier position with growth potential.

Qualifications

• Minimum 3 years of workers' compensation claims handling.
• California Claims Certification/License required.
• Knowledge of investigation, coverage analysis, reserving, and settlement negotiations.
• Experience handling complex and litigated claims.
• Proficiency with MS Office and claims management systems.

Responsibilities

• Manage a caseload of workers' compensation claims, including investigation, evaluation, reserving, and claim resolution.
• Analyze policy coverage and determine compensability.
• Authorize payments and manage claim expenses within authority limits.
• Negotiate settlements and develop effective claim resolution strategies.
• Coordinate with attorneys, medical providers, nurse case managers, underwriters, agents, and insureds.
• Identify potential fraud concerns and coordinate with appropriate investigative resources.
• Maintain accurate claim documentation and prepare reports for management.
• Ensure compliance with California workers' compensation regulations and industry standards.

Skills

Investigation

Negotiation

Analytical thinking

Communication

CMS / claims systems

Education

Bachelor's degree or equivalent

California Claims Certification/License

Tools

Claims Management System (CMS)

Microsoft Office

Job description

Workers' Compensation Claims Adjuster II

Location: Brea, CA (Hybrid)
Pay Rate: $45-$50/hour
Duration: Contract with Potential for Full-Time Conversion

Our client is seeking an experienced Workers' Compensation Claims Adjuster II to manage California workers' compensation claims from investigation through resolution. This position offers a hybrid work schedule and the opportunity to join a well-established insurance organization with the potential for long-term career growth.

Responsibilities

• Manage a caseload of workers' compensation claims, including investigation, evaluation, reserving, and claim resolution.
• Analyze policy coverage and determine compensability.
• Authorize payments and manage claim expenses within authority limits.
• Negotiate settlements and develop effective claim resolution strategies.
• Coordinate with attorneys, medical providers, nurse case managers, underwriters, agents, and insureds.
• Identify potential fraud concerns and coordinate with appropriate investigative resources.
• Maintain accurate claim documentation and prepare reports for management.
• Ensure compliance with California workers' compensation regulations and industry standards.

Qualifications

• Minimum 3 years of workers' compensation claims handling experience.
• California Claims Certification/License required.
• Strong knowledge of claims investigation, coverage analysis, reserving, and settlement negotiations.
• Experience handling complex claims and working with litigated files.
• Excellent communication, analytical, negotiation, and problem-solving skills.
• Proficiency with Microsoft Office and claims management systems.
• Bachelor's degree or equivalent experience preferred.
• Professional designations such as AIC, CPCU, or similar are a plus.

Why Consider This Opportunity?

• Competitive pay of $45-$50/hour.
• Hybrid work environment with flexibility.
• Opportunity to work with an established insurance carrier.
• Potential for contract extension and full-time conversion.

Qualified candidates with California workers' compensation claims experience are encouraged to apply.