Remote Workers Compensation Adjuster III

Summary

The Workers Compensation Adjuster III is responsible for managing an assigned inventory of claim files, performing three-point contact on all new losses within 24 hours, documenting ongoing case facts, forming a partnership with the medical case manager to maximize early return to work potential, and assuring that the claim file is handled in accordance with applicable statutes and service contracts. The position requires a high degree of claims handling expertise, a Bachelor's degree or equivalent combination of education and experience, and at least seven years related experience.

Requirements

• Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them
• Litigation management - Direct, manage, and control the litigation process
• Education and/or Experience: Bachelor's degree (B.A.) from four-year college or university; at least seven years related experience and/or training; or equivalent combination of education and experience
• Requires a high degree of claims handling expertise to include a minimum of at least five years experience managing indemnity cases, many with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues & possess an SIP certificate

Responsibilities

• Perform a three-point contact on all new losses within 24 hours of receipt of the claim to include the claimant, employer, and treating physician
• Thoroughly and accurately document ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and what is being done to move the case toward closure
• Assure that all assigned indemnity claims have an up to date plan of action outlining activities and actions anticipated for ultimately resolving the claim
• Form a partnership with the medical case manager to maximize early return to work potential thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs
• Initiate the referral to the SIU of cases with suspected fraud
• Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability

Preferred Qualifications

Competency: To perform the job successfully, an individual should demonstrate the following competencies: Problem Solving, Customer Service, Interpersonal, Team Work