Workers Compensation Claims Adjuster | Brea, CA

Sedgwick•Brea, CA

About The Position

The Workers Compensation Claims Adjuster analyzes mid- and higher-level workers compensation claims to determine benefits due, ensures claims are adjudicated within company standards and industry best practices, identifies subrogation opportunities, and negotiates settlements. The role manages long-term indemnity claims, monitors reserve accuracy, files required state documentation, develops and manages claim action plans through resolution, coordinates return-to-work efforts, and approves claim payments. It also includes communicating claim actions to claimants and clients, maintaining accurate claim files and coding, and maintaining professional client relationships. The adjuster may handle complex lifetime medical or defined-period medical claims, including state and physician filings and decisions about treatments recommended by utilization review. Other duties may be assigned; the role supports quality programs and travels as required.

Requirements

Three years of California workers compensation claims management experience, or an equivalent combination of education and experience.
California jurisdictional knowledge.
SIP certification is required or must be obtained within one year of employment.
Ability to think clearly and conceptually and demonstrate excellent judgment, troubleshooting, problem-solving, analysis, and discretion.
Ability to handle work-related stress, manage multiple priorities simultaneously, and meet deadlines.
Ability to perform computer keyboarding and to hear, see, and talk.

Nice To Haves

Bachelor's degree from an accredited college or university preferred.

Responsibilities

Manage workers compensation claims, determine compensability and benefits due on long-term indemnity claims, monitor reserve accuracy, and file necessary documentation with state agencies.
Develop and manage workers compensation claim action plans through resolution.
Coordinate return-to-work efforts and approve claim payments.
Approve and process assigned claims, determine benefits due, and manage action plans pursuant to the claim or client contract.
Manage claim subrogation and negotiate settlements.
Communicate claim actions with claimants and clients.
Ensure claim files are properly documented and claims coding is correct.
May process complex lifetime medical or defined-period medical claims, including state and physician filings and decisions on treatments recommended by utilization review.
Maintain professional client relationships.
Support the organization's quality programs.
Travel as required.
Perform other duties as assigned.