Senior Workers Compensation Adjuster

TPI Global Solutions; Roseville (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

TPI Global Solutions is seeking a Senior Workers Compensation Adjuster in the United States to manage high-value casualty claims with minimal supervision.

Role requires advanced investigative and negotiation skills, and collaboration with legal counsel and technical specialists to ensure thorough claim evaluation and resolution.

Qualifications

• Bachelor's degree preferred or equivalent experience.
• 5–10+ years of workers' compensation claims handling with an insurer.
• Must possess or obtain state adjuster licenses and CE credits.
• Skilled in negotiating complex claims and development of strategies for outcomes, including litigation and compliance.
• Deep understanding of regulatory environment and jurisdictional requirements.
• Ability to manage escalated claims with professionalism and clear judgment.

Responsibilities

• Independently manage moderate to complex, high-value casualty claims; lead investigations and assess coverage.
• Identify opportunities to transfer risk and pursue subrogation; negotiate with stakeholders for optimal outcomes.
• Ensure all claims activities comply with regulatory and company standards; maintain detailed records and reports.
• Set reserves and authorize payments within authority; contribute to reserving accuracy.
• 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 analytics to identify trends and improve claims handling; protect PII.

Skills

Investigations

Negotiation

Litigation management

Data analytics

Regulatory compliance

Mentoring

Stakeholder communication

Leadership

Education

Bachelor's degree preferred

Job description

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.

In this role, you will:

• 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.

What you need to apply:

• 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.
• Possesses in-depth understanding of the regulatory environment and jurisdictional requirements.
• Effectively manages escalated claims and sensitive customer concerns with professionalism and clarity.