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Workers' Compensation Claims Adjuster

4 months ago

Glendale, United States California Insurance Guarantee Association Full time

Effectively manage (analyze, plan, take action and document) assigned claims in a timely and ethical manner with a high degree of professionalism.
- Documented analysis and evaluation of coverage under both Insurance code 1063 and applicable insurance policies, statutory law, liability defenses and case dispositions.
- Provide direction and assistance to defense counsel in support of the litigation effort and in the negotiation of claims settlements within assigned authority levels by undertaking timely litigation recommendations made to counsel on each assigned litigated claim.
- Undertaking a thorough analysis of the economic considerations impacting each litigated or potentially litigated claim.
- Maintain sufficient and detailed documentation of activities and decisions associated with each assigned claim contained within the claims diary, claims notes, claims coding, claims imaging, and claims reporting systems of CIGA.
- Evaluate, negotiate and settle assigned claims. Prepare Authorization Requests for reserve and settlement authority on claims that exceed granted authority.
- Independently evaluate, negotiate and settle (or deny) assigned claims. Prepare Authorization Requests for reserve and settlement authority on claims that exceed granted authority.
- Evaluate, negotiate and settle (or deny) bodily injury and property damage claims. Prepare Authorization Requests for reserve and settlement authority on claims that exceed granted authority.
- May attend hearings at the Workers’ Compensation Appeals Board as necessary.
- May attend mediations / settlement conferences.
- Mentor claims adjusters and co-workers that have less experience with claim evaluation, strategies, and plans of action for the handling of claims.
- Providing reasoned and well thought out solutions on issues raised by vendors, claimants, and the adjuster’s supervisor.
- A demonstrated ability to serve as back-up to the unit supervisor as needed or requested.
- Detailed understanding of job related California Labor Code, Section 1063 and 14.2 of the California Insurance Code, including keeping current with changes and potential developments.
- A comprehensive understanding of CIGA’s statutory defenses.
- An ability to analyze economic and financial data and to reach well thought out conclusions.
- An assertive claims handling approach while maintaining focus on multiple claims parameters.
- An ability to identify a problem, analyze the cause, and determine an acceptable solution in a timely manner within the scope of the position.

**Position Knowledge and Skills Requirements**:

- **Education**:Baccalaureate degree from an accredited college or university preferred, but not required. An industry certification from the Insurance Education Association, Insurance Institute of America, Workers’ Compensation Self Insurance Certification or a California Experienced Claims Adjuster Designation.
- **Experience**: Minimum of 5-10 years of experience administering California claims. Litigation experience preferred.
- **Special Knowledge**:Intermediate Microsoft Office software skills, in particular Excel, Word and Outlook. Experience with PowerPoint, Publisher, and Adobe Acrobat.
- **Skills**: High level of literacy and arithmetic skills, as demonstrated by activities or achievements in or out of the work environment. Excellent communication skills, interpersonal skills, ethics, and cultural awareness. Ability to think analytically. Concern for order, quality and accuracy. Ability to work independently.

Pursuant to state and local laws the pay range for this position is $36.19 - $54.21 per hour.

Pay: From $36.19 per hour

Expected hours: 40 per week

**Benefits**:

- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible schedule
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Professional development assistance
- Tuition reimbursement
- Vision insurance
- Work from home

Schedule:

- 8 hour shift
- Day shift
- Monday to Friday

Work setting:

- In-person
- Office

**Experience**:

- claim adjusting: 10 years (required)

Work Location: In person