Worker Compensation Claims Adjuster I

Description

Summary:

Under close supervision, analyzes insurance claims to determine extent of insurance carrier's liability and settles claims with claimants in accordance with policy provisions by performing the following duties.

Essential Duties and Responsibilities:

• Three-point contact, initial investigation, initial benefit determination.
• Ability to identify and address questionable (AOE/COE) claims.
• Establish and monitor reserves at periodic intervals.
• Prepare claims status report to carriers at 90-day intervals.
• Ability to manage and direct medical care, including strategies to maintain medical control and objection when appropriate.
• Identify and rate permanent disability. 
• Vocational Rehabilitation file management
• Negotiate and finalize claim settlements as well as lien settlements.
• Identify and manage subrogation issues on workers’ compensation claims.
• Work independently and in a fast paced environment. 

Requirements

Competency:

To perform the job successfully, an individual should demonstrate the following competencies: 

• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics. 
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. 
• Interpersonal - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things. 
• Team Work - Supports everyone's efforts to succeed.

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Education and/or Experience:

At least 1-3 years experience as a Workers’ Compensation Claims Assistant, or up to one year Trainee or Future Med Adjuster experience; or Bachelor’s degree (B.A.) and six months experience.

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.