Sr. Workers' Compensation Adjuster, CA

Department:

Job Description:

As a Senior Workers Compensation Adjuster you will be 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 litigation management.

The role carries settlement authority up to $175000 and involves handling a broad
range of claims.

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 strong organizational skills self-direction and the ability to manage competing priorities independently. Additionally the adjuster may provide mentorship or support to junior team members in their claims handling.

Accountabilities:

• Investigate coverage and determine compensability in accordance with California workers compensation laws

• Establish and maintain appropriate reserves

• Manage indemnity and litigated claims including exposure analysis and settlement strategy in compliance with California Regulations.

• Collaborate with defense counsel to evaluate exposure and drive claims toward timely and equitable resolution

• Maintain timely and accurate claim file documentation in accordance with company protocols

• Coordinate medical management including UR/IMR and return-to-work strategies

• Prepare clear and professional written communications and reports

• Participate in claim reviews and case discussions

• Maintain diary system in accordance with company standards

• Coordinate medical management including UR/IMR and return-to-work strategies

• Identify and address claims with Medicare exposure

• Identify and pursue subrogation opportunities

• Recognize potential fraud indicators (red flags) and refer cases to SIU as appropriate

• Assign and oversee vendor resources ensuring quality and timeliness of services

• Communicate effectively with internal and external stakeholders and provide mentorship to junior staff

Qualifications:

• 5 years California workers compensation claims experience

• Current Experienced Adjuster Designation

• Bachelors degree preferred

• Experience adjusting complex indemnity and litigated claims

Core Skills:

• Advanced knowledge of California workers compensation regulations and laws

• Ability to work independently and efficiently in a remote environment

• Excellent analytical and problem-solving abilities

• Effective verbal and written communication skills

• Ability to negotiate skillfully in challenging situations.

• Strong organizational and time management skills with ability to prioritize competing demands

• Proficiency with Microsoft Word Excel and Outlook

• Ability to perform advanced mathematical calculations

Pay Range:

Anticipated Hiring Range:

• $79500 - $110000 annual base salary depending on experience qualifications and geographic location

Benefits:

We are proud to offer our full-time regular employees a robust benefits suite that includes:

• Competitive base salary plus incentive plans for eligible team members

• 401(K) retirement plan that includes a company match of up to 6% of your eligible salary

• Free basic life and AD&D long-term disability and short-term disability insurance

• Medical dental and vision plans to meet your unique healthcare needs

• Wellness incentives

• Generous time off program that includes personal holiday and volunteer paid time off

• Flexible work schedules and hybrid/remote options for eligible positions

• Educational assistance

Equal Opportunity Employer

The Mutual Groupis an Equal Opportunity Employer. It is our policy to recruit hire train and promote individuals in all job classifications without regard to race color religion sex national origin age veteran status disability sexual orientation gender identity or any other characteristic protected by law.

• Know Your Rights: Workplace Discrimination is Illegal

• Your Rights Under USERRA

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact.

Employment Verification

The Mutual Group participates in theE-Verifyprogram and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. You are protected fromemployment discriminationbased on your citizenship status and national origin.

E-Verify Program Overview

E-Verify Participation Poster

All offers of employment are contingent upon the successful completion of a background check.

#TMG