Senior Claims Adjuster | California

Employers Holdings; Las Vegas (NV); Remote; USD 60,000 - 85,000; Full time

Job summary

Employers Holdings is seeking a Senior Claims Adjuster I to manage workers' compensation claims accurately and timely. This remote position involves handling complex cases, evaluating claims data, and collaborating with various stakeholders to ensure compliance and service excellence. Candidates must have experience with California work comp claims and relevant certifications.

Benefits

Comprehensive benefits package

Positive work environment

Qualifications

• Experience adjusting California work comp claims is required.
• Preferred certifications: WCCP, AIC, ARM, CPCU.
• Must demonstrate strong analytical and customer service skills.

Responsibilities

• Manages workers' compensation claims with minimal oversight.
• Collaborates with legal teams for case management.
• Mentors team members and shares expertise.

Skills

Analytical skills

Customer service

Problem-solving

Education

Bachelor’s degree or equivalent business experience

Job description

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Location: Must live in the US and work WEST COAST HOURS Remotely

Requisition Number: req186

General Summary

With minimal oversight, the Senior Claims Adjuster I is responsible for the timely and accurate management of workers' compensation claims. This includes handling medical and indemnity benefits, addressing litigation and complex issues, and managing moderate to high exposure cases.

Must work West Coast hours (M-F 8am-5pm PST) and have experience adjusting CALIFORNIA work comp claims.

Essential Duties and Responsibilities

• Completes initial contacts to obtain necessary information, verify coverage, determine compensability and develop a plan of action. Completes and maintains work comp claim data integrity.
• Independently analyzes case facts to establish timely and accurate reserves using knowledge and experience with medical disabilities and related costs, as well as judgment of extent of disability.
• Collaborates with Corporate Workers' Compensation Claims to proactively evaluate and mitigate high exposure losses.
• Provides timely and appropriate customer service within established best practices. Maintains ongoing professional communications with all internal and external customers.
• Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines. Files appropriate state forms, as needed.
• Proactively manages or coordinates medical treatment to continue to move the work comp claim forward. Uses internal and external resources to contain costs and manage exposure.
• Reviews and analyzes litigation and legal issues. Directs legal strategy and participates in preparation of the case for litigation. Collaborates with defense attorney to move workers' compensation claims to resolution.
• Completes detailed settlement analysis and recommends appropriate settlement value, utilizing in-depth 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.
• Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure. Uses a high degree of independent judgment to render accurate decisions.
• Mentors other team members and acts as a Subject Matter Expert for legal, jurisdiction and Company needs.
• Other duties as assigned.

Certification

• WCCP, AIC, ARM, CPCU or other insurance designation preferred.

Education

• Bachelor’s degree or equivalent business experience preferred.
• Remote: This role is a remote (work from home (WFH) opportunity, 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

Salary Range: $60,000- 85,000 and a comprehensive benefits package, please follow the link to our benefits page for details! https://www.employers.com/careers/our-benefits-and-perks/

About EMPLOYERS

As 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 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.

Compensation details: 60000-90000 Yearly Salary

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  Insurance

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