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Claims Adjuster I

2 months ago

Glendale, California, United States EMPLOYERS Full time
Job Summary

As a Claims Adjuster I at EMPLOYERS, you will play a critical role in the timely and accurate management of workers' compensation claims with low to moderate medical and indemnity benefit exposure and minimal litigation.

Key Responsibilities
  • Receive and review new claims involving low to moderate medical, indemnity, and occasional legal exposure.
  • Complete initial contacts to obtain necessary information, verify coverage, determine compensability, and develop a plan of action.
  • Analyze case facts to establish timely reserves using and building knowledge of medical-related costs and judgment about extent of disability.
  • Provide timely and appropriate customer service within established best practices.
  • Maintain ongoing professional communications with all internal and external customers.
  • Evaluate and pay benefits in compliance with statutory and company guidelines.
  • File appropriate state forms, as needed.
  • Proactively coordinate or monitor medical treatment to continue to move the claim forward.
  • Use resources, internal and external, to contain costs and manage exposure.
  • Work with supervisor to review and analyze some legal issues.
  • In collaboration with defense attorneys, proactively handle and mitigate exposure to litigation and price up claims for minor settlements.
  • Regularly review caseload and proactively take action to guide claims efficiently and effectively to closure.
Requirements
  • Excellent communication and customer service skills and knowledge of an imaged environment.
  • Self-motivated with excellent analytical, problem-solving, and decision-making skills. Strong ability to multi-task and prioritize.
  • If state certification or license is required, must meet certification within state-mandated timeframe and maintain any required license through continuing education.
  • Must have High School Diploma or GED equivalent.
  • Preferred but not required:
    • One to two years of related claims, medical, legal, or insurance industry experience.
    • Knowledge of workers' compensation laws, regulations, and statutes.
    • Bachelor's degree or equivalent business experience.
    • WCCP, AIC, ARM, CPCU, or other insurance certification.
Work Environment

This role is remote and open to candidates currently located in the United States and able to work without sponsorship. It requires a suitable space that provides a private and quiet workplace.