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Claims adjuster Jobs in Santa Clara, CA
- Promoted
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501 CSAA Insurance Services, Inc.California, United StatesSR. WORKERS' COMPENSATION CLAIMS ADJUSTER
EliteCA, United States- Full-time
This position will be a remote position.
Must have a California SIP (Workers Compensation - Sr. Work Comp Claims Adjuster)
Must be Bilingual (English / Spanish)
POSITION SUMMARY : Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.
DUTIES AND RESPONSIBILITIES :
- Effectively manages a caseload of 130 to 140 workers' compensation files, including very complex claims.
- Initiates and conducts investigation in a timely manner.
- Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
- Manages medical treatment and medical billing, authorizing as appropriate.
- Refers cases to outside defense counsel. Directs and manages as appropriate.
- Communicates with claimants, providers and vendors regarding claims issues.
- Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.
- Settles and / or finalize all claims and obtains authority as designated.
- Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
- Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
- Adheres to all Company policies and procedures.
- Conducts file reviews independently.
- Other duties as assigned.
- Essential job function.
EQUIPMENT OPERATED / USED : Computer, fax machine, copier, printer, and other office equipment.
QUALIFICATIONS REQUIRED :
Education / Experience : Bachelor's degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.
Knowledge, Skills and Abilities :
Other Qualifications :
Here are some of the benefits you can enjoy in this role :