Sr. Workers' Compensation Adjuster - California I Remote Opportunity in CA, San DiegoApply

Sr. Workers' Compensation Adjuster - California

The Senior Workers' Compensation Adjuster is responsible for managing moderate to complex workers' compensation claims from initial investigation through resolution. Key responsibilities include conducting interviews with insured parties, claimants, witnesses, and other relevant individuals to assess claim eligibility; obtaining statements; analyzing coverage; determining compensability and applicable benefits; setting appropriate reserves; negotiating settlements; and advising on potential litigation.

The role carries settlement authority up to $175,000 and involves handling a broad range of claims. Guidance from the home office is typically reserved for high-value, unique, or multi-dimensional cases that exceed settlement authority.

This is a remote position requiring minimal supervision. The ideal candidate will be well-versed in standard claims practices and procedures, and will rely on professional judgment and experience to achieve objectives. The role demands versatility, problem-solving skills, and a degree of creativity. Additionally, the adjuster may provide mentorship or support to junior team members in their claims handling.

Accountabilities

• Investigates coverage, determines compensability, initiates and controls delivery of accurate and timely compensation workers' compensation benefits, monitors medical management, determine accurate and adequate reserves on assigned claims.
• Provides accurate assessments and negotiates fair and efficient claims resolutions while managing costs. Settles losses according to the documented damage, the language of the policy of insurance, pertinent regulatory and statutory considerations and within granted authority.
• Prepares written communication, including but not limited to settlement letters, disclaimers of coverage and reservation of rights letters.
• Maintains effective claim file documentation and diary system. Monitor diary to achieve timely development of file and timely disposition of the claim.
• Recognizes and pursues recovery opportunities and prepares submissions to SIU when indicated.
• Assigns and supervises vendor resources, including but not limited to independent adjusters, engineers and other experts as needed.
• Assumes additional duties as defined.

Qualifications

Compensation

Benefits

We are proud to offer a robust benefits suite that includes :