Claims Adjuster I | California

(workers' compensation) | 100% Remote Opportunity (WFH)

General Summary

Under direct supervision, the Workers Compensation Claims Adjuster I is responsible for timely and accurate management of workers’ compensation claims with low to moderate medical and indemnity benefit exposure and minimal litigation.

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

Essential Duties And Responsibilities

• Receives and reviews new claims involving low to moderate medical, indemnity and occasional legal exposure. Caseload may include complex Medical Only claims.
• Completes initial contacts to obtain necessary information, verify coverage, determine compensability and develop a plan of action. Completes and maintains accurate claim system data.
• Analyzes case facts to establish timely reserves using and building knowledge of medical-related costs and judgment about extent of disability.
• 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 guidelines. Files appropriate state forms, as needed.
• Proactively coordinates or monitors medical treatment to continue to move the claim forward. Uses resources, internal and external, to contain costs and manage exposure.
• Working with supervisor, reviews and analyzes some legal issues. In collaboration with defense attorneys, proactively handles and mitigates exposure to litigation and prices up claims for minor settlements.
• Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure.
• Other duties as assigned.
  
  

Requirements

• One to two years of workers' compensation claims, medical, legal or insurance industry experience.
• Excellent communication and customer service skills and knowledge of an imaged environment.
• Self-motivated with excellent analytical, problem solving and decision-making skills.
• Strong ability to multi-task and prioritize.
• Knowledge of workers’ compensation laws, regulations and statutes preferred.
  
  

Certification

• If state certification or license is required, must meet certification within state-mandated timeframe and maintain any required license through continuing education.
• WCCP, AIC, ARM, CPCU or other insurance certification a preferred.
  
  

Education

• Must have High School Diploma or GED equivalent.
• Bachelor’s degree or equivalent business experience preferred.
  
  

Work Environment

• 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: $40,000- 65,000 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.