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Senior Claims Adjuster - California

Company: International Executive Service Corps
Location: Glendale
Posted on: January 25, 2023

Job Description:

Worker's Compensation Senior Claims Adjuster - California - 100% Remote OpportunityWorking PST hours (M-F 8am-5pm PST / M-F 11am-8pm EST)
EMPLOYERS - Insurance Group (EIG) is dedicated to supporting our injured workers and insureds. Our Senior Claims Adjusters manage a caseload of complex workers' compensation insurance claims, as well as determines compensability, set reserves, process payments, and aggressively negotiates settlement of claims. This position offers an exciting opportunity for the Claims Professional who is empathic, organized, and able to manage their time within a growing organization and high-performing team! #LI-Remote HP22
Requirements:


  • Active California Worker's Comp certification preferred.
  • Minimum of 6 years' experience working in a claim's environment at the Adjuster level or higher managing lost time claims of a complex nature.
  • Ability to communicate effectively both orally and in writing
  • Strong customer service and relationship-building skills
  • Strong organization, planning, and execution skills, with ability to meet deadlines consistently
  • Attention to detail
  • Microsoft Office (e.g., Word, PowerPoint, Excel, Outlook)
  • Continuous improvement mindset

    Essential Functions:

    • Receive and review information related to new claims involving no or minimal lost time from work. May manage a number of claims that are more complex. Communicate with injured workers, employers, and medical providers. Determine compensability based on contact information, accident reports, and statutes. Understands and adheres to Claims Best Practices.
    • Assigns case to contactor if applicable for investigation of circumstances when compensability is questionable.
    • Accurately calculates and pays appropriate benefits in a timely manner.
    • Set up file diaries, manage medical treatment, establish reserves up to authority level, submit reserve recommendations of higher level for authorization, and file required State forms. Document follow-up care, actions taken to settle claim and other claim related activity.
    • Review case facts to identify possible fraud or abuse throughout course of claim.
    • Follow up with contacts to medical provider and insured employer regarding injured workers' progress. Review reserves and adjust as required. Support the process by scheduling medical or testing appointments and providing authorizations. Demonstrate sound medical management skills and aggressive claims handling, proactively pursuing return to work.
    • Develops, monitors, and adheres to a written plan of action to facilitate ongoing claim management.
    • Manage legal issues under the direct guidance of claims adjuster or supervisor that can be adjudicated without the use of a defense attorney. May direct legal strategy and participate in preparation of case for next level(s) of litigation.
    • Review and respond to incoming mail, emails, telephone calls and fax transmissions from providers and injured worker, related to caseload. Take actions required to respond within regulations and policy.
    • Review and approve or deny medical bills.
    • Always conduct business with the highest standards of personal, professional, and ethical conduct.
    • Ensures timely compliance with all policy and procedures as well as jurisdictional statutes.
    • Established and maintains ongoing professional communications with all appropriate parties, internal and external.
    • Maintains professional and technical knowledge by attending employer sponsored training classes.
    • Visits employers relative to claims management, as required.
    • All other duties as assigned or as situation dictates.

      Pay Range $65,000 - $85,000(discussed on first interview)
      Employers Insurance Group (EIG), 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 profitably grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS.
      Headquartered in Reno, Nevada, EMPLOYERS attributes its long-standing success to our most valuable resource, our employees. 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, and 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.

Keywords: International Executive Service Corps, Glendale , Senior Claims Adjuster - California, Other , Glendale, Arizona

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