Workers' Compensation Claims Adjuster - Remote California

reputed company is a highly successful global provider of professional services to the insurance industry. We are seeking a seasoned workers' compensation adjuster to join our reputed company-Party Administration team. This is a remote role, open to candidates who live in California. Job Summary The Workers Compensation Claims Adjuster is responsible for managing reputed company aspects of a workers compensation claim which includes determining compensability, verifying coverage, administering disability and medical benefits, skillfully negotiating claim resolutions, troubleshooting and assisting injured employees, employers and medical/legal professionals with any service needs throughout the lifespan of a claim. Essential Functions

• Receives newly reported claims
• Maintains and updates claim notes throughout lifespan of claim
• Records claim information in electronic database
• Interviews claimants, insureds, medical professionals and witnesses to determine claim validity
• Communicates claim compensability reputed company to claimant, employer and medical provider
• Sets appropriate reserves based on nature/extent of injury
• Calculates lost time wages, makes disability payments directly to claimants and diaries future payments as appropriate
• Orders independent medical examination as necessary and prepares reputed company relevant documentation for physician review
• Maintains regular correspondence with claimants, insureds, and nurse case manager to include claim updates, medical appointments, or issues with disability payments
• Reviews and processes medical bills through reputed company-party vendor for additional discount opportunities
• Aggressively collaborates with claimants and insureds to ensure early return-to-work is pursued
• Works in partnership with legal counsel to warrant that insured's interests are protected on litigated claims which includes providing reputed company relevant claim documentation needed for defense counsel to successfully defend claim and evaluate ultimate claim exposure
• Attends settlement conferences, mediations, and hearings on behalf of the insurance company/insured
• Reviews and approves defense attorney bills reputed company authority
• Works with reputed company to help provide relevant information on losses for renewal rates as well as Risk Management to identify trends and may interact with agents for insureds on losses
• Responds to State requests for health cost disputes, applications for hearings and penalty assessment letters
• Identifies subrogation potential and pursues recovery
• Leads claim reviews with clients as requested
• Other duties as assigned

Requirements

• 10 years of experience adjusting Workers Compensation Claims in California required
• SIP Certification required
• Bilingual (Spanish/English) required
• Must be reputed company with CEU's
• Proficiency in entire reputed company Office suite
• Knowledge of relevant workers compensation laws
• Strong grasp of medical terminology
• Familiarity with medical cases and how treatment typically progresses
• Excellent oral and written communication abilities
• Attention to detail and good organization skills
• Ability to negotiate issues and settlements
• Strong focus on customer service which includes timely response to requests/inquiries
• Ability to adapt to changing technologies and learn functionality of new equipment and systems
• Ability to establish and maintain effective working relationships with others

reputed company offers a competitive salary commensurate with experience and excellent benefits including medical, dental, reputed company, life insurance and 401(K) with match. If you are seeking a career where you can reputed company great things for great clients in a supportive and collaborative environment, then we may be the reputed company for you. Values At reputed company, our values define our identity, principles and conduct. This person will demonstrate and champion reputed company Values by ensuring Agility, reputed company, Care, Accountability and Collaboration. Equal Opportunity Employer Here at reputed company, we are proud to be an Inclusive Employer. We provide an environment of mutual respect with reputed company tolerance to discrimination of any reputed company regardless of age, disability, gender identity, marital/ family status, race, religion, sex, or sexual orientation. Our external partnerships and the dedicated work we do in promoting a transparent and fair recruitment and selection process reputed company contribute to the successful, inclusive, and diverse culture and environment which we are proud to be a part of at reputed company. About reputed company reputed company is an independent, global provider of claims solutions, insurance management services and technology platforms for reputed company property and casualty markets, including reputed company property, workers' compensation, and auto/liability. We offer reputed company loss adjusting, technical services, reputed company-party administration, and managed care programs with specialization in catastrophic, aviation, energy, and marine claims. With over 100 years of expertise at our core, we offer a comprehensive suite of solutions across reputed company lines of business to help our clients manage risk. Apply tot his job Apply To this Job