Workers' Compensation Claims Adjuster - Remote California
Claims SpecialistClaims SpecialistFull TimeRemote
Location
United States
Posted
5 days ago
Salary
$90K - $110K / year
No structured requirement data.
Job Description
Charles Taylor is a highly successful global provider of professional services to the insurance industry. We are seeking a seasoned workers’ compensation adjuster to join our Third-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 all 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.
The Workers Compensation Claims Adjuster is responsible for managing all 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 decisions 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 all 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 third-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 all 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 within authority
- Works with underwriting 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 current with CEU's
- Proficiency in entire Microsoft 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
Charles Taylor offers a competitive salary commensurate with experience and excellent benefits including medical, dental, vision, life insurance and 401(K) with match. If you are seeking a career where you can achieve great things for great clients in a supportive and collaborative environment, then we may be the place for you.
Values
At Charles Taylor, our values define our identity, principles and conduct. This person will demonstrate and champion Charles Taylor Values by ensuring Agility, Integrity, Care, Accountability and Collaboration.
Equal Opportunity Employer
Here at Charles Taylor, we are proud to be an Inclusive Employer. We provide an environment of mutual respect with zero tolerance to discrimination of any kind 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 all contribute to the successful, inclusive, and diverse culture and environment which we are proud to be a part of at Charles Taylor.
About Charles Taylor
Charles Taylor is an independent, global provider of claims solutions, insurance management services and technology platforms for all property and casualty markets, including commercial property, workers’ compensation, and auto/liability. We offer complex loss adjusting, technical services, third-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 all lines of business to help our clients manage risk.
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