Senior Workers Compensation Adjuster

WCF Insurance • Roseville, CA

3d • $44 - $55 • Hybrid

About The Position

This is a non-exempt position that reports to the Supervisor, California Claims. The person in this position investigates, documents, and determines coverage and liability for complex industrial claims and provides prompt and fair benefits. This role may be structured as either hybrid or fully remote, depending on candidate qualifications and business needs. The pay for this position is $43.75 – $55.19 hourly.

Requirements

• Extensive knowledge of California Workers' Compensation laws, regulations, and procedures.
• Knowledge of State Audit (PAR) requirements.
• At least five years of claims adjusting experience handling complex, litigated cases.
• High literacy level in medical terminology and concepts.
• Ability to communicate effectively, both orally and in writing.
• Excellent organization, time-management, and decision-making skills.
• Bachelor's degree or AIC designation or equivalent work experience.

Responsibilities

• Perform initial and ongoing claims investigations.
• Communicate claims decisions and key developments to injured workers and policyholders.
• Provide clear documentation to ensure the proper functioning of claims adjusting processes.
• Manage disability and medical benefits for eligible injured workers.
• May act as section supervisor in claims manager's absence.
• Communicate claims decisions and key developments to injured workers and policyholders.
• Manage disability and medical benefits for eligible injured workers.
• Maintain appropriate communication with internal and external contacts including employers, injured workers and their families, medical providers, attorneys, investigators, and the Labor Commission.
• Carefully investigate and monitor each claim to make sure that benefits are fair and timely and to identify any potential fraud or third-party recovery.
• Make appropriate, timely referrals to the subrogation department and special investigations unit.
• Demonstrate proficiency and consistency in applying WCF's claims standards.
• Ensure accuracy of claims reserves, working independently within the reserve limit.

Benefits

• Our benefits package includes competitive medical, dental, and vision insurance coverage.
• It also includes a profit‑sharing bonus based on company performance, a 6% 401(k) match, and a generous PTO package in which you accrue 4 weeks of vacation your first year-with an additional 40 hours of PTO gifted upon hire.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior