Workers Compensation Claims Adjuster

• Adheres to all policies and procedures in managing claims
• Investigates the claim and coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured, claimant, witnesses and medical providers.
• Evaluates, establishes, maintains and adjusts reserves based on fact, company standard and experience.
• Proficiently negotiate claims, turning adverse perspectives into quick resolution. Gains trust of other parties to negotiations and demonstrates good sense of timing. Approaches discussions from merits or strengths of case.
• Utilize strong critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret and understand key or root issues.
• Establishes effective relationships with internal or assigned counsel for customized defense plan. Applies company principles and standards including planning, organizing and monitoring legal panel services and cost in partnership with internal legal counsel.
• Communicates with internal managed care and medical resources to ensure coordination with medical providers, injured workers and employers in developing return to work strategies and treatment plans.
• Obtain medical records (past and present), police, ambulance and other agency reports as required.

Qualifications:

• Bachelor’s degree or equivalent experience

• 3+ years WC claims experience

• CA Adjusting License

• Demonstrated skills in investigation, evaluation and negotiation

• Strong knowledge of insurance practices