Senior Workers Comp Claims Adjuster

About This Role

Handle a caseload of workers' compensation claims, ensuring compliance with state statutes and client guidelines. This role involves investigation, coverage analysis, settlement negotiations, and potential fraud identification.

Responsibilities

• Handle a 110 caseload commensurate with the complexity level of claims assigned
• Establish facts of loss, coverage analysis, investigation, compensability/liability/negligence determination
• Coordinate medical care as appropriate
• Manage litigation and assess damages
• Conduct settlement negotiations and identify potential fraud
• Manage vendors, analyze reserves, and complete reports
• Ensure compliance with state statutes, client guidelines and NARS Best Practices
• Address claim metrics in a timely and appropriate manner
• Identify, analyze, and confirm coverage
• Make contact with parties and clients within eight business hours
• Communicate with parties and providers to determine liability, compensability, negligence, and subrogation potential
• Obtain necessary information and explain benefits as appropriate
• Maintain regular contact throughout the life of the claim process
• Assist with training/mentoring of Claims Adjusters
• Assist management with projects or leadership as requested
• Support management and handle various duties/responsibilities of the Assistant Unit Manager/Unit Manager as delegated in their absence
• Refer all files identified with subrogation potential to the subrogation department
• Maintain closing ratio as dictated by management team
• Close all files as appropriate in a timely and complete manner
• Verify facts of loss and pertinent claims facts such as employment, wages, or damages
• Establish disability with treating physicians as appropriate

Requirements

• CA Adjuster License and Experience

Nice to Have

• Ability to attend conferences
• Ability to attend client meetings
• Ability to mentor other adjusters
• Ability to assist management