Hybrid Senior Workers Comp Claims Adjuster (CA SIP)

Elite Tek Services, Inc.; Concord (CA); Hybrid; USD 85,000 - 95,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Disability & Life Insurance

401(k) plan

Paid time off

Paid holidays

Job summary

A leading company is seeking a Sr. Work Comp Claims Adjuster to manage all aspects of indemnity claims. This hybrid role includes overseeing complex claims, ensuring compliance with regulations, and collaborating with clients and vendors. Benefits include comprehensive health plans, a 401(k), and paid time off.

Qualifications

• Five or more years related experience required.
• Ability to manage very complex claims independently.
• Certifications as required by state regulation.

Responsibilities

• Manage a caseload of 130 to 150 workers’ compensation files.
• Determine compensability and administer benefits based on state law.
• Communicate with claimants, providers, and vendors regarding claims issues.

Skills

Analytical skills

Excellent written and verbal communication

Technical knowledge of statutory regulations

Education

Bachelor’s degree in related field

Tools

Word

Excel

Job description

Sr. Work Comp Claims Adjuster (SIP Cert required - Concord, CA)

• Concord, CA

Workers Compensation - Sr. Work Comp Claims Adjuster)
Must have a California SIP

Salary/Pay: Salary is $85,000 - $95,000

(Hybrid Position requiring two (2) days in the office)

POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

DUTIES AND RESPONSIBILITIES:

• Effectively manages a caseload of 130 to 150 workers’ compensation files, including very complex claims.
• Initiates and conducts investigation in a timely manner.
• Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel. Directs and manages as appropriate.
• Communicates with claimants, providers and vendors regarding claims issues.
• Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Adjuster I and Claims Adjuster II.
• Settles and/or finalize all claims and obtains authority as designated.
• Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
• Adheres to all Company policies and procedures.
• Conducts file reviews independently.
• Other duties as assigned.

* Essential job function.

EQUIPMENT OPERATED/USED: Computer, fax machine, copier, printer, and other office equipment.

QUALIFICATIONS REQUIRED:

Education/Experience: Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities:

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).

Other Qualifications:

• Certifications and/or licenses as required by State regulation.

Here are some of the benefits you can enjoy in this role:

• Medical, Dental, Vision, Disability & Life Insurance