Workers' Compensation Claims Adjuster - Remote Southern California

Charles Taylor plc•California, MD

40d•Remote

About The Position

Charles Taylor is a highly successful global provider of professional services to the insurance industry. We are seeking a seasoned workers' compensation adjuster to join our Third-Party Administration team. This is a remote role, open to candidates who live in Orange or Los Angeles County. Team meetings and training sessions are held in person at our Long Beach office a few times each year. Job Summary The Workers Compensation Claims Adjuster is responsible for managing all aspects of a workers compensation claim which includes determining compensability, verifying coverage, administering disability and medical benefits, skillfully negotiating claim resolutions, troubleshooting and assisting injured employees, employers and medical/legal professionals with any service needs throughout the lifespan of a claim.

Requirements

10 years of experience adjusting Workers Compensation Claims in California required
SIP Certification required
Bilingual (Spanish/English) required
Must be current with CEU's
Proficiency in entire Microsoft Office suite
Knowledge of relevant workers compensation laws
Strong grasp of medical terminology
Familiarity with medical cases and how treatment typically progresses
Excellent oral and written communication abilities
Attention to detail and good organization skills
Ability to negotiate issues and settlements
Strong focus on customer service which includes timely response to requests/inquiries
Ability to adapt to changing technologies and learn functionality of new equipment and systems
Ability to establish and maintain effective working relationships with others

Responsibilities

Receives newly reported claims
Maintains and updates claim notes throughout lifespan of claim
Records claim information in electronic database
Interviews claimants, insureds, medical professionals and witnesses to determine claim validity
Communicates claim compensability decisions to claimant, employer and medical provider
Sets appropriate reserves based on nature/extent of injury
Calculates lost time wages, makes disability payments directly to claimants and diaries future payments as appropriate
Orders independent medical examination as necessary and prepares all relevant documentation for physician review
Maintains regular correspondence with claimants, insureds, and nurse case manager to include claim updates, medical appointments, or issues with disability payments
Reviews and processes medical bills through third-party vendor for additional discount opportunities
Aggressively collaborates with claimants and insureds to ensure early return-to-work is pursued
Works in partnership with legal counsel to warrant that insured's interests are protected on litigated claims which includes providing all relevant claim documentation needed for defense counsel to successfully defend claim and evaluate ultimate claim exposure
Attends settlement conferences, mediations, and hearings on behalf of the insurance company/insured
Reviews and approves defense attorney bills within authority
Works with underwriting to help provide relevant information on losses for renewal rates as well as Risk Management to identify trends and may interact with agents for insureds on losses
Responds to State requests for health cost disputes, applications for hearings and penalty assessment letters
Identifies subrogation potential and pursues recovery
Leads claim reviews with clients as requested
Other duties as assigned