Sr. Workers' Compensation Adjuster - California I Remote Opportunity

Job Description

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.

Skills/Requirements Qualifications:

• Bachelor's degree preferred
• 5-8 years in the handling of Workers Compensation Claims.
• Knowledge of Workers Compensation Law.
• Multi-line claim handling experience beneficial.
• Ability to take responsibility and work independently in a home-based environment.
• Strong communication and analytical skills are required.
• Ability to negotiate skillfully in difficult situations.
• Must have strong organizational and time management skills.
• Ability to formulate sound expense, indemnity, and business judgment while supporting loss evaluations and presenting them effectively.
• State licensing or certification where required.
• Basic computer skills including Microsoft applications Word, Excel, Outlook, and the Internet.
• Perform work related simple and advanced mathematical problems and calculations.
• Compose written correspondence and factual reports which are well-organized and concise, utilizing proper English, grammar, punctuation, and spelling.
• Demonstrates the ability to use commonly used claims concepts, practices, and procedures.
• Convey clear, concise information to others, using verbal or other appropriate communication techniques.
• Complete formal training plan and assignments as required.
• Treat others in a nondiscriminatory, lawful, and ethical manner, respecting the differences among people, and the value they bring to The Mutual Group.
• Follow safe practices in all work activities to avoid injuries and accidents.

Compensation

• $68,700 - $100,000 commensurate with experience, plus bonus eligibility
• $75,600 - $115,000 commensurate with experience in CA, CT, MA, NJ, NY, and PA, plus bonus eligibility

Benefits

We are proud to offer 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

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